tag:blogger.com,1999:blog-23659309911423267962024-03-08T13:44:46.654-06:00Dysgraphic Musings of a Busy Medical Studenteefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.comBlogger44125tag:blogger.com,1999:blog-2365930991142326796.post-3547131115870408972016-07-20T17:21:00.000-05:002016-07-31T10:26:35.432-05:003rd Year Chronicles: Emergency Medicine<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12pt; line-height: 107%;">"I
was trying to get a buzz," he slurred before closing his eyes and dropping
off to sleep again.</span></div>
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<br /></div>
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<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">I
had just walked in to an evening shift in the ER and had picked up my first
patient of the night. He had come in after taking about five tabs of methadone
earlier that morning that he had bought off someone. After ingesting them
earlier this morning, he spent the next few hours "falling out"
(fainting) about four times at home. Once he had "sobered up," he
decided maybe that wasn't normal and he should come and get checked out. <o:p></o:p></span></div>
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</div>
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<br /></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEilFPlh8bk56USAqBWsOPERl6JdAY-tchqVY1tZjEt0A2OUAoR3HBM6zbgmn6yrpiq1lQ2UjXvytG8TAv9oequNcZnx8iyiX6V8J6RPbe_NZjD0XeP56Tp5ewwGjReXZuy-h3RlybN1kvI/s1600/emergency_med_hero.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="135" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEilFPlh8bk56USAqBWsOPERl6JdAY-tchqVY1tZjEt0A2OUAoR3HBM6zbgmn6yrpiq1lQ2UjXvytG8TAv9oequNcZnx8iyiX6V8J6RPbe_NZjD0XeP56Tp5ewwGjReXZuy-h3RlybN1kvI/s400/emergency_med_hero.jpg" width="400" /></a><span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">Probably
a good idea.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">We
went through all of the usual questions – no, he said he didn't take anything
else. No, he wasn't trying to kill himself. No, no other medical issues. He was
groggy but conversational, his vitals were normal at the moment, and he wasn't
having any acute issues so after we talked and I examined him I left to go find
one of the ER attendings to discuss what to do about this guy going forward.
Even though he had been using sedating medications, passing out several times
and falling at home isn't normal. Also, his EKG (an electrical picture of what
his heart was doing for a few seconds) was a little bit abnormal, so he was
likely going to buy himself a bit of a workup and likely admission.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">The
night went on. I walked out of another patient's room a little bit later and
went to a computer to check on the workup of some of my patients so far and
noticed that the methadone guy had been moved to one of the resuscitation
rooms. Turns out he had an episode of ventricular tachycardia (a very fast,
abnormal heart rhythm) that was caught on the heart monitor in his room. It was
short but that's definitely not normal, so he was moved to a room where we
could watch him more closely and intervene if needed.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">Turns
out, that was also a good idea.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">Shortly
after his first brief episode of "v-tach," he went into another one –
longer this time. He had a pulse but wasn't responding – the heart wasn't able
to pump enough blood to the brain. We had already put the defibrillator pads on
him, so after he became unresponsive we started charging the machine and
delivered the shock. He almost jumped off the stretcher, but immediately he was
awake and the monitor was demonstrating a normal heart rhythm again. The
attending started a constant infusion of a medication called amiodarone to
hopefully keep his heart rhythm normal and we started working to get this guy
upstairs to the ICU for further observation and care.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">Turns
out, his heart had other plans. As we were working in his room, he became
unresponsive. V-tach again. He had a pulse. Charge, clear, shock, jump, awake. <i>Breathe</i>.
Time to get this guy upstairs. We began to wheel him out of his room into the
hallway towards the doors to the elevator when he became unresponsive again.
Again, he still had a pulse. Charge, back to the room, clear, shock, jump,
awake. <i>Breathe</i>. <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">This
happened five times in a space of a few minutes. This guy needed to be sedated
so we could continue to care for him and shock him if needed. That means we
needed to "take his airway," or intubate him – put a long breathing
tube down through his mouth, past his vocal cords, and into his lungs. <o:p></o:p></span></div>
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<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;"><br />
As it happened, the day before we had just had a (timely, it turns out) skills
session learning how to intubate, run a code, and use the defibrillator. As we
were preparing to intubate him, the attending turned to me and asks, "Have
you ever done this before?" <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">"Nope…
but we did just practice yesterday."<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">He
hands me the blade, a short curved metal instrument with a handle that you
insert into the patient's mouth while standing behind their head to sweep the
tongue to the side and lift up the soft tissues of the jaw to expose the vocal
cords, which hide deep in the throat. "You're up."<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">Well
ok then.<o:p></o:p></span></div>
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<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;"><br />
We run through the pre–intubation checklist (in medicine, as with most things,
the most important part of any task is the preparation). Suction. Bag-valve
mask at the ready. Oxygen on the patient. Blades. Tubes. Meds. All of the tools
we need to place the airway and make sure it's in the right place when we are
done. Finally, it's time. He has been paralyzed and is now depending on us to
breath for him, which means we have a limited amount of time to get things in
place.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">The
day before, we had practiced on plastic mannequins. Their airways were, well,
plastic and actually really hard to work with. You have to lift up on the
handle of your blade once it's inserted in the mouth to expose the cords, but
you have to be careful about how you lift – if you lift the wrong way, you'll
break their teeth. With the mannequins, you almost had to lift the disembodied
torso off the table to visualize the cords. <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">Human
tissue, it turns out, is a lot more pliable. I opened the patient's mouth,
inserted the blade (<i>this is the side to put it in on, right?</i>), swept the
tongue aside, and lifted the blade towards the corner of the room, surprised at
how easy everything was move out of the way.<o:p></o:p></span></div>
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<br /></div>
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<i><span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">Breath
in.</span></i><span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;"><o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">This
is the part where everything falls into place or falls apart. Almost
immediately, I could see the floppy epiglottis hanging down, obscuring my view.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">"Push
the blade in just a bit further."<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">I
eased the tip of the blade in just a bit further behind the epiglottis, lifted
up just a bit more… and there they were. Beautiful pearly white cords. <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">"I
see the cords." <o:p></o:p></span></div>
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<br /></div>
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<i><span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">Breath
out.</span></i><span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;"><o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">I
held out my hand and someone handed the endotracheal tube to me. They tell you
that, once you see the cords, you should never look away – you don't want to risk
losing them. I inserted the tube into his mouth, guided it towards his glottis,
and was relieved to see the tube passing easily through the cords.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">"I'm
through." <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">My
job was over for now – I removed the blade, we secured the tube, and began
taking care of all the other tasks that need to happen once someone is
unconscious and depending on a team of strangers to help them breathe.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">______________<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">That
night was probably one of the more memorable moments of my month in emergency
medicine and certainly embodies some of the reasons why I personally think the
specialty is one of the best jobs in medicine, but it certainly isn't how the
whole month went. Every other shift was filled with hours of seemingly more
mundane encounters – sorting through which chest pain patient might actually be
having a heart attack, which belly pain patient was actually having an
abdominal emergency, helping patients who came in short of breath to rest a bit
easier, and figuring out which kids were potentially sick or not. Not all of it
was fit for prime time TV, but I thought it was one of the best months of
medical school. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">It
was very different than all of the rest of my third year rotations. The pace,
the patients, the focus – it was a huge paradigm shift from working on the
floors or in clinic. In the ER, you had to move fast or drown in the sea of
patients waiting just outside the double doors in the waiting room. While
upstairs I might have had the opportunity to spend an eternity chart reviewing
a new patient, poking through their old medical records, and even writing most
of my note before I even had to go see them, when I was in the emergency
department I was lucky to see their initial vitals and a triage note before I
walked into the room. You had to think on your feet and form your differential
diagnoses at the bedside and walk out of the room after a brief encounter with
at least an initial plan of action. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">One
of the doctors, on my first shift, spent a few minutes giving me and another
student a few pointers before sending us off to see patients. "In the
ER," he said, "you don't have time to think. Don't think. Just do.
You have to do your thinking outside of the ER." And for the most part,
that proved to be true. If there was something I didn't know about on the
floors, it wasn't unusual for me to have some time, at least in the afternoon,
to sit down and read about a topic for a few minutes. That wasn't typically the
case here – if I needed to look something up before presenting a patient, I had
maybe a couple of minutes tops before I would start running behind. You really
had to spend time off of your shift thinking through how you would react in the
first few minutes of any given patient encounter, what your initial actions would
be, what questions you'd ask, what physical exam portions you'd emphasize, what
your top differential diagnoses would be, and how you'd go about working that
patient up, if at all. <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">We
spent about half of our shifts over the course of the month working at Loyola
and the other half working at a community hospital nearby. Personally, I
actually really enjoyed the community shifts more – at Loyola, a large tertiary
care center, there was a "team" for everything (strokes, heart
attacks, trauma, etc.) and a separate pediatrics section. So while we stayed
plenty busy, it seemed like everyone had their hand in the pot. At the
community center, it was you, a couple of other docs, and the waiting room. You
saw all the patients, did most everything that needed doing, and functioned
like you'd imagine an emergency medicine physician would. <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">As
I've mentioned in previous posts, as I progressed through third year I realized
I really enjoy practicing the breadth of medicine. As I spent time in various
specialties, I was always impressed at the level of knowledge required within
that particular field but always missed "everything else." I knew
that I didn't want to be a "knee guy" or a "liver guy."
Instead, I always have found it appealing to do a bit of everything. In the
introduction chapter to <i>Harwood–Nuss' Clinical Practice of Emergency
Medicine</i>, the author writes the following:<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">"Practicing
emergency medicine is like carefully lining up a putt, then dropping the
putter, picking up a tennis racket to return a volley or two, quickly side–stepping
an onrushing tackler, and then returning to sink the putt." <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">Another
doctor/writer said that "Emergency Medicine is the most interesting 15
minutes of every other specialty." Essentially, it's perfect for someone
like myself who enjoys most aspects of medicine in general and really doesn't
have an interest in spending the rest of my career focusing on a limited number
of medical conditions. That said, EM provides plenty of opportunities to become
a "master" at whatever particular bit of medicine you find more
interesting than the rest – for example, sports medicine, toxicology, emergency
cardiology, resuscitation, and so on. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">I've
been interested in EM since before medical school. In fact, it's what got me
interested in medicine in the first place. Going through medical school, I've
tried to put it on the backburner, keep an open mind, and explore other fields,
but nothing else really sticks out to me like this one. When I picture being a
"doctor," I've always pictured someone who could handle just about
anything. There are few fields that fit that description, but I think EM is one
of the best at meeting that criteria. Obviously no field does everything.
Medicine is a team sport and every field has its limits, EM included. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">One
interesting thing about EM is that it is practiced in bit of a fish bowel –
that is, everyone is watching. All the hospital staff who take over on the patient
you admitted for whatever reason can see everything you've done so far in that
patient's care and workup. And at least at academic centers, and especially in
residents, it's sometimes <i>en vogue</i> to
make fun of something that was done during the patient's stay in the ED. It
seems to be less of an issue with actual attendings or in community settings,
but it's just an interesting phenomenon I've noticed. What's often overlooked
is that the same Monday-morning quarterbacking is often done from the comfort
of a small, quiet room somewhere tucked away in the hospital with the benefit
of 1) more time (the best diagnostician, by far) and 2) more complete
information (in part because of the workup that is currently being mocked).
Sure, we know the patient's not having a heart attack <i>now</i>, the morning
after they were admitted. But that's something you only can tell using your
trusty “retrospectoscope,” which unfortunately wasn't available to the ED
physician at 1 am last night. Additionally, the practice of EM can be radically
different than the practice of medicine on the floors – less information,
higher stakes, faster paced. Sometimes that means maybe an extra test or two
were ordered in the interest of time, or maybe some treatment was initiated
that <i>technically</i> could have waited, but that's the game. Finally, what
they may sometimes forget is that for every admission, veritable hordes of
patients were seen, treated, and “street-ed” from the ED. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">If
you're interested in EM, just be aware that there are those with very vocal
opinions about the field (and often other fields as well). I would just say to
smile and nod and realize 1) they honestly have no idea what they're talking
about. It's not their fault; they just don't know how things work in the ER.
And 2) I've noticed that oftentimes the loudest critics (whether of EM or any
other field) seem to be trying really hard to convince themselves that they
chose the right field for themselves. If you want to learn the pros and cons of
the field, talk to an actual ER doctor. So there's that. Just play along, keep
a thick skin, and don't lose sight of what's important – that is, choosing the
right field for <i>you</i>, not your burned–out resident. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">Speaking
of burnout, that's another concern that's commonly voiced about emergency
medicine. More than likely, it's a valid concern for a lot reasons – the shift
work can be brutal (especially as you get older), the actual practice can vary
a lot depending on what environment you are in, the pace can be soul–crushing,
etc. But if you look at some of the burnout data from the </span><a href="http://www.medscape.com/features/slideshow/lifestyle/2016/public/overview" target="_blank"><span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">Medscape surveys</span></a><span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">, burnout is really an issue with medicine in general,
not just EM. And while EM can be found near the top of lots of the charts
related to the prevalence of burnout in various fields, you'll notice that the
difference between EM and the next ten fields is pretty minimal (a few
percentage points). What's also interesting is that while the prevalence of
burnout in EM may be a little bit higher than other fields, the <i>severity</i>
of that burnout is lower (even that that of, for example, family medicine, a
number of surgical fields, and even internal medicine). The problem isn't so
much with EM as it is with medicine in general – the landscape of medical
practice is shifting and more and more is being expected of doctors as it
relates to metrics and paperwork <i>in addition </i>to good old patient care,
which is what we all – presumably – went into the field for in the first place.
Preventing burnout is a topic unto itself and has a lot written about it by
people smarter than myself, but suffice it to say that there <i>are</i> things
we can do to minimize the risk of burning out. For example, keeping your
priorities straight (e.g. decreasing shifts at the expense of some income),
keeping yourself healthy, quickly doing away with your medical school debt and
setting yourself on the path to achieving financial independence so you aren't
chained to your job, and making room for a Plan B (e.g. a fellowship into a
different niche of medicine or perhaps a different career path entirely) are
all good places to start. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt; line-height: 107%;">Ultimately,
finding the specialty that's right for you can be a bit of a journey. You might
have one in mind at the beginning of medical school. Or not. You might end up
sticking with that specialty. Or not. You might bounce back and forth between
several seemingly unrelated specialties throughout third year and maybe even
into the beginning of your fourth year when you absolutely have to choose (or
just go into internal medicine to defer the choice for another three years… I
kid, I kid). For me, though, I'm excited to begin the residency application
process for emergency medicine and looking forward to what the future holds.</span></div>
eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com0tag:blogger.com,1999:blog-2365930991142326796.post-12926731117009214252016-07-03T14:07:00.000-05:002016-07-03T14:07:03.226-05:003rd Year Chronicles: Medicine, Neurology, and Choosing a Specialty<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Times New Roman", serif; font-size: 12pt;">Third
year is officially over now, which means I’ve completed three more rotations
without posting anything more on the blog. Which means it’s time to sit down
and write something. I’ll try and briefly cover my internal medicine and
neurology rotations in this post, and then emergency medicine (my last rotation
of the year) will get its own post. </span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"><b>Internal
Medicine</b><o:p></o:p></span></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJElifHWX4APgNkIiBTOFF-SRX5l4kOf-krhW8zqQS7Ae6HS4YlwSvfdW_1Ghi9xpxwSTUFoUSlWHXoZQze4KutZsS8cEWlma9-eezMPZcaM1sDGxYfattBv9HE2Qe7_d-Yg53Cpq_dTc/s1600/med-specialties1.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="178" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJElifHWX4APgNkIiBTOFF-SRX5l4kOf-krhW8zqQS7Ae6HS4YlwSvfdW_1Ghi9xpxwSTUFoUSlWHXoZQze4KutZsS8cEWlma9-eezMPZcaM1sDGxYfattBv9HE2Qe7_d-Yg53Cpq_dTc/s320/med-specialties1.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="https://behindnorthwind.files.wordpress.com/2013/02/med-specialties1.jpg" target="_blank">How to Choose Your Specialty</a></td></tr>
</tbody></table>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">Together
with surgery, the internal medicine (or simply “medicine,” as it’s more
frequently called) rotation forms the latter half of the third year gauntlet
through which we all must pass. Ideally, after completing these rotations, one
is expected to have a very rough idea of the expanse of medicine and at least a
general idea of what they may want to do when they grow up. That may or may not
be the case in actuality, but that’s another post entirely. <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">My
medicine rotation was eight weeks long. The first half the rotation took place
on the “wards” or “floors” at Loyola and the second half was at the VA hospital
immediately next door (or at least a long walk away). The hours were fairly
typical hospital hours but significantly better than surgery – we were there at
6 am to get sign out from the overnight team and, depending on which site we
were at, how busy the day was, and whether or not our team was admitting new
patients, would get out between 4 – 5:30 pm. The one weekend day we had to work
was shorter – we’d usually be done by noon, sometimes a little later, sometimes
sooner. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">Most
of the work happened in the morning. We’d get in, hear about any overnight
events for our patients, round on them, and see any new admissions we knew
about already. Depending on the morning, we might have a meeting or lecture,
and if we were lucky we’d have a few minutes to touch base with our residents
to talk about our plans before we rounded with the attending. Some of the
attendings like to sit down talk through the patients first and then go see
them (this was ideal, I thought, and typically a bit more efficient), while
others liked to do bedside rounds. Either way, this process could take anywhere
from an hour and a half on a good day to three hours or more on a… less good
day. Once that was over, the rest of the day was spent seeing any more new
patients that were admitted, writing notes, following up on consults, or
whatever busywork was left over. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">Each
day was fairly routine. The medicine itself was sort of the “bread and butter”
of hospital medicine. This was the biggest service in the hospital and
accounted for the vast majority of the inpatients. Day-to-day work usually
involved tweaking medications to achieve the desired result and seeing what
happened or waiting on labs, imaging, or other workups while we were trying to
get at a diagnosis. There was something nice about the predictableness of
everything – there was a certain way everything was done and certain time to do
everything. While it was busy at times, this was the service, more than any
other (except for perhaps neurology), where our attendings loved to sit and
discuss what was going on and what odd things might be (but probably weren’t)
contributing to our patients’ current problems. This was also the first
rotation for a long time where I didn’t have some form of clinic – everything
was on the floors. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">Since
this is one of the third year “gauntlet” rotations, it was busy and when it
came to studying I had to pick and choose which resources I actually could use.
As usual, I started out the rotation with grand plans of getting through Step
Up to Medicine, all of the UWorld medicine questions, and reading about
individual patients. As it turned out, Step Up just put me to sleep after a
long day on the wards and I didn’t have the time to get through even half of
all my original goals as it was, so about three weeks in I just switched to
reading about different patient problems on UptoDate and doing as many UWorld
questions as I could (ended up getting through around half of them). That said,
since I had had surgery first, that seemed to be sufficient to do well enough
on the end of rotation shelf. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">As with
most rotations, I enjoyed medicine. I already know I wanted to practice the
“breadth” of medicine, and general medicine certainly fits the bill. Also,
doing an internal medicine residency is a fairly safe bet – this is the path
you need to go down anyway to “unlock” many of the fellowships into medical
subspecialties (think cardiology, gastroenterology, rheumatology, critical
care, etc.). That being said… I am not a fan of rounding. There are certainly
ways to make it less painful, but sitting around talking about patients for
hours every day just isn’t my idea of a good time. I like seeing patients and
doing things for them, but that only comprised a small portion of my day. The
rest was spent mostly on the phone calling consults or on the computer chart
reviewing or writing notes. Stuff that needed to be done, sure, and not exactly
unique to medicine (emergency medicine certainly has more than its fair share
of phone and computer time too), but that was all. day. long. I did appreciate
the intellectual aspect of the field – medicine people like to sit around and
talk about the endless possible etiologies or sequelae of a given disease
process. And that’s not a bad thing – I enjoy learning or refreshing my memory
about a given disease process as much as the next guy, and many of the
residents and attendings I had the privilege of working with were incredibly
intelligent and had a lot to teach (some, not so much, but hey – that’s life). Of
course, all of this isn’t necessarily reflective of what one’s day-to-day would
look like in one of the many possible subspecialties, but that’s a conversation
for later. All in all, I feel like this is the field I might fall into if EM didn’t
exist and I decided to not go down the family medicine path. I might consider
doing a combined medicine-pediatrics residency if that were the case, though,
because I really do enjoy seeing kids – not something you get to really do with
a run of the mill IM residency.</span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"><b>Neurology</b><o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">Once
I crested the hill of the third year, fourth year and its fruits were in sight.
My first taste was with neurology – a four week rotation that, by some odd
design, was almost more “shadowing” than actual work. With medicine and surgery
and most other third year rotations so far, I had been busy working as part of
the team, seeing patients, and increasing my workload as much as I could (or at
least pretending to do all of that, even if what we were doing wasn’t all that important).
With neurology, things were a bit different. First off, instead of having maybe
one or two other medical students on your team, there were five of us, which
made for a bit of a different dynamic. Second, the residents weren’t quite sure
what to do with us. Finally, we had all just made it through the hardest part
of third year and were ok with relaxing at least a little bit. Regardless,
there were no weekends with this rotation, which was beautiful, and we
typically didn’t need to get to the hospital until 7 – 7:30 am, which was also
beautiful. To top it off, the residents started looking at us funny if we were
there past 4 pm, and often sent us home closer to 3 pm or so. This must be why
all the fourth years look so happy.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">We
spent two weeks of the rotation on “wards,” or the neurology inpatient service,
and two weeks on the neurology consult service with some clinic smattered in
there once a week or so (which was actually one of the more useful parts of the
rotation where I actually got to practice my neuro exam a bit and get some one
on one time with an attending). I will say that most of the residents and a
couple of the attendings (well, one) did try to take some time out of their day
to teach us some useful things (reading MRIs, managing seizures, etc.) which is
always helpful and appreciated by students.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">Most
of our patients were either on the floors or in the neuro ICU after having a
stroke, being worked up for seizures, or having some other assorted
neurological condition (multiple sclerosis flare, intractable migraines, etc.).
This, above all else, is the rotation where people loved to stand around and
talk about exactly what part of the central or peripheral nervous system was
probably affected by some lesion, and then order or look at imaging or some
other study where possible to confirm it. Unfortunately, unless you were an
interventional neurologist (a fellowship that allows you to go in and pull out
clots within a certain timeframe after a stroke), it felt like most of our
energy was spent figuring out what was going on and then watching and waiting
to see what happened. There were exceptions, of course, and obviously there are
important things that need to be done or medications that need to be started to
reduce the risk, for example, of having a future stroke or seizure, but overall
I felt like time was the most important treatment for many things (“Oh, you had
a stroke? Well, we have a clot-busting drug that may or may not actually work,
depending on how long ago the stroke was and if you believe the industry-funded
literature or not, and might cause harm, but we can try that. And then we’ll
start some meds to hopefully prevent this from happening again, and see if time
and physical therapy might fix some of your new deficits. Thanks bye.”). This
isn’t to bash neurology – it’s an incredible field with many new developments
coming down the pipeline, and many of its practitioners are incredibly
intelligent with an amazing grasp of neurological anatomy and pathophysiology. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">Again,
though, I found myself missing the “rest” of medicine. I brushed up on my neuro
exam, but I think I might have used my stethoscope maybe a handful of times the
entire rotation. Overall, it’s not for me but I really do think it’s a great
field with a lot of opportunities and some cool fellowships (for example,
interventional neurology or movement disorders, where you really can change
people’s – with Parkinson’s, for example – lives for the better). <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;"><b>Some
Thoughts on Choosing a Specialty</b><o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">Figuring
out what you want to do when you grow up is hard, and it doesn’t stop once you
figure out “Hey, being a doctor seems like a good idea.” Then you have to sort
out which niche in the house of medicine is the one you want to spend the rest
(or at least most) of your career in.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">Thankfully,
there are enough different paths in the broad world of medicine for almost
everyone to find something they can at least tolerate. It’s generally a good
sign if you get through your preclinical years and especially your third year
feeling like you enjoyed most things – if you’ve hated every day of your life
up until this point, all hope isn’t lost but you may have to work a bit harder
to seek out your field. There are a lot of things we don’t get exposed to in
our core rotations, and a number of fields that we may not see in our entire
medical school experience unless we actively seek them out. AAMC’s Careers in
Medicine website is a good resource for exploring many of the possible
branching paths in medicine that may be a helpful place to start. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">Many
people start with the “medicine vs. surgery” decision, and that’s a good place
to begin. Another way to think about things is to consider if you want to be "the
expert" in a particular field (e.g. a heavily subspecialized IM or surgical
field). The downside to that is you spend your days doing just that. Or would
you rather be comfortable with and deal with a lot of different things on a day
to day basis (family medicine, general IM, med/peds, EM)? The downside there is
you may be good at certain things (e.g. with family medicine - taking care of
the “whole person,” etc.; in EM, you're an expert in working up an
undifferentiated patient, managing every field's emergencies, etc.) but won't
necessarily function at the level of an "expert" in whatever field
you happen to be dabbling in that day. Do you want your life to be all or
mostly medicine (e.g. a surgical field or some procedural-heavy medicine
subspecialties) or do you want to do things outside of medicine (e.g. 9-5
office based practice, etc.)? And again, there's also lots of nooks and
crannies in medicine that you don't really get exposed to until much later in
school, if at all.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">Also,
(almost) every field has its “action hero” moments, but most of your time on a
day-to-day basis will be bread-and-butter cases. It’s important to
differentiate between the two and not pick a field with few-and-far-between
“action hero” moments that you love but a daily grind that you hate. You need
to find something that you can at least tolerate on a day-to-day basis or you’re
going to hate life and burnout quickly. Using emergency medicine as an example,
you get to do some cool stuff – run codes, intubate patients, maybe bring
people back to life, do some awesome procedures, and maybe save some lives. But
most every day, your shift will involve endless waves of chest pains that
aren’t heart attacks, belly pains that aren’t emergencies, and the drunks who
consume time and resources you don’t have. If you can’t do the grind, don’t do
the field. The “awesome saves” in EM certainly aren’t happening every shift or
even every month. But we can talk more about EM in the next post. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">Bottom
line: keep an open mind. Explore things. Talk to people. Try and arrange
rotations or at least shadowing experiences in fields that you are interested
in. Understand that you likely would be happy in more than one field. Don’t
feel pressured to choose a field right when you start medical school, or even
when you’re halfway through third year. Maybe start feeling a little pressure
once fourth year is about to start, but beyond that… take your time finding
your field, and choose it for you, not based on any expectations that you think
your friends or family have. Don’t choose a field to impress, choose one that
you truly enjoy. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt;">And
regardless of what you choose… maybe think about a Plan B, just in case. That’s
life, sometimes.</span></div>
eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com2tag:blogger.com,1999:blog-2365930991142326796.post-61668016325056315892016-03-04T16:44:00.001-06:002016-04-07T15:14:36.299-05:003rd Year Chronicles: Surgery<!--[if gte mso 9]><xml>
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<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<i><span style="color: black;">BEEP BEEP BEEP BEEP</span></i><span style="color: black;"></span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">The unrelenting wail of my pager cut through the heaviness
of my dreamless sleep. I opened my eyes and fumbled to turn it off before it
woke the person trying to sleep a couple of bunks over from me in the call
room. It was a text page. </span></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisKBpD6cU3JD_F1uMN2nlTTScfgiMfCWZslprrJoWNsQE9ZkEJSDH_MCZZXPlc2OCO8_KkGv_MVijSoTU0UMJY_Polj10QTD28Yx2bYxnDn2Ld39FxqPXdiVEoyA9irmR5sbjDlvc-7OQ/s1600/getty_rf_photo_of_surgery_in_progress.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="217" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisKBpD6cU3JD_F1uMN2nlTTScfgiMfCWZslprrJoWNsQE9ZkEJSDH_MCZZXPlc2OCO8_KkGv_MVijSoTU0UMJY_Polj10QTD28Yx2bYxnDn2Ld39FxqPXdiVEoyA9irmR5sbjDlvc-7OQ/s320/getty_rf_photo_of_surgery_in_progress.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Someone is eager to retract...</i></td></tr>
</tbody></table>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">"Come to CT in the ED."</span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">It was almost 1 am on a Friday night. I was on trauma call
at Loyola at the end of my third of eight weeks on my surgery rotation. For the
first half of the rotation, my days had been spent on the vascular surgery
service at the nearby VA hospital. </span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">The days were long - I usually was there around 4:30 am to
prepare the patient list, round on my post-operative patients, and write my
notes before rounding again with the team around 6 am or so. After rounding,
our usual two or three cases would keep us in the OR from anytime until noon on
a short day to 4 pm or later on a longer one. After a few hours of taking care
of miscellaneous tasks throughout the hospital, seeing consults, attending
lectures, and checking on our patients in the afternoon I was usually able to
finally leave the hospital anywhere from 5 pm on a good day to 8 pm or so on a
longer one. </span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">When I came home, I was pulled between needing to read up
on the next day's cases, trying to get some general studying in for our surgery
shelf exam at the end of the rotation, preparing any presentations that I had
been asked to give, taking care of what felt like a million different
miscellaneous things that needed to be squared away before fourth year and
residency applications began, and – most importantly – spending as much time as
possible with my wife and son. Sleeping was usually on the list in there
somewhere, too.</span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">After a few weeks on that merry-go-round, I was exhausted.
During the days, it was difficult to find time to eat, drink, or use the
bathroom. When I finally got home at the end of the day, I really just wanted
to sit down with my family in front of the electric heater in our living room –
the older house we are renting doesn't stay very warm when it is in the single
digits outside – and just relax with them, chase my son around the house, and
spend time with my wife.</span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">But there was no going home tonight. Fridays were busy days
anyway at the VA. In the mornings, we rounded as usual and then went to several
hours of conference. After taking care of any miscellaneous tasks on the
floors, we then went to clinic. Technically, it was scheduled for three hours.
But since they routinely tried to squeeze in 40-45 patients in that time span,
it was something we all dreaded each week. The clinic was always ridiculously
crazy and fast-paced, and by the time we were getting to the end of the
afternoon – several hours behind schedule at that point – the patients were
almost all (understandably) peeved about having to wait so long.</span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">Of course, that made things even more enjoyable. Once the
patients were all seen, we would breathe a sigh of relief and start writing our
notes – which would usually take up the next couple hours – and finishing up
things on the floors for the day. After that, we finally would go home.</span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">Tonight, though, was different. After finishing clinic, but
before getting a chance to write my notes for that day, I headed over to Loyola
to start my overnight trauma call. After meeting up with my resident for the
night, we spent the next few hours seeing random consults and admissions
throughout the hospital. Finally, around 9 or 10 pm, things started to slow
down a bit. I went to the call room to try get a little bit of studying in, but
that didn’t last long. I quickly fell into a deep, empty sleep. That,
apparently, wasn't how I was going to spend the rest of the night.</span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">After I found my shoes, threw on my white coat, and tried
to quietly fumble my way out of the call room, I headed downstairs to the
emergency department and found the imaging room. A small group was huddled
around the screens displaying images that were just being taken of the patient lying
on the table in the CT machine beyond the glass pane. They weren't very
promising images, either.</span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">The story we initially heard was that a teenager
was found by friends after he had slipped on ice and hit his head. We'll call
him Peter. EMS arrived about 15 minutes later and he was brought to the ED,
where he was intubated and sedated since he had a significantly decreased level
of consciousness and was agitated on arrival.</span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">The images we saw, though, suggested someone wasn't telling
the whole story. This kid had two different skull fractures and bleeding all
throughout the brain. His brain was swelling in response to the injury and
essentially trying to escape through the hole in the bottom of the cranial
vault and his pupils were fixed and dilated – a very bad sign of neurological
injury. Had this been anyone else – anyone other than a young kid - it more
than likely would have been deemed that any significant intervention wouldn't
change the prognosis, which was very poor. Since Peter was younger, though,
they had to at least try. Nevertheless, the odds of him surviving were grim. </span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">After some further imaging, neurosurgery placed an external
ventricular drain – basically something that amounts to a catheter inserted
through a hole they drill in the skull to drain some of the fluid that normally
circulates throughout the brain to reduce intracranial pressures. If the
increased pressures continued, they would kill him. </span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">Normally when the drain is inserted, the clear fluid
normally dribbles out the end of the catheter. In his case, though, the fluid
was spurting out the end of it like water does when you put your finger over
the end of a hose. Not a good sign.</span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">Around this time, the family was starting to trickle in. We
eventually learned from one of Peter's friends that he had actually hopped on
top of the hood of a slow-moving car that the friend was driving. The friend
was startled and quickly hit the brakes, throwing Peter off of the hood of the
car and to the ground, where he hit his head.</span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">Soon after the drain was inserted, the patient went back to
the OR. There, the neurosurgeons essentially lifted up the left half of his
scalp from his skull and then removed the exposed portion of the skull – the
entire left side of his head. The whole time, the brain seemed like it was
trying the escape the room. When they finally cut through the dura mater – a
thick covering over the brain that normally protects and encloses it – it
finally was allowed to swell without compressing itself on the inside of the
skull.</span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">By the time they got to this point, I was around maybe hour
25 or 26 of my shift. I was exhausted. Not only had the preceding week been
incredibly busy and sleep been scarce, but I knew I still had at least a couple
of hours of work ahead of me – before I left, I needed to go back to the VA to
wrap up my notes from the prior day. </span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">All throughout medical school, we had been warned about
various studies demonstrating a decrease in the measured "humanity"
or empathy of students that has been observed from when they start their first
year as compared to when they finish. The steepest drop often happens in third
year. So far, I felt like this hadn't been really been an issue. I've enjoyed
most of my rotations so far, I've enjoyed my patients, and I've had a good time
overall. I've even really enjoyed my surgery rotation. Taking part in patient
care, being a part of the medical team, and learning "real medicine"
has been very satisfying.</span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">Tonight, though, was different. Tonight, as I was standing
near the head of the bed, watching this young kid fight a losing battle for his
life… I realized something.</span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">I didn't care.</span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">That wasn't entirely true. There was a small part of me,
deep down, that was breaking for Peter and his family. We've all done stupid
things before, but now this young man was paying for it with his life. But
there was a bigger part of me, a more immediate and present part, that didn't
feel any of that. A part of me that just wanted to go finish my notes and go to
sleep for the next week. </span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">I could easily explain this away as a bad day on my part. I
could say that I was just exhausted, and that things would be better after a
day off and decent night's sleep. And maybe all that is true. But the fact
remained that I found myself that night experiencing something I never really
thought I would – a distinct, undeniable feeling of indifference for a patient.
Something that I would sometimes see in residents or attendings who were
further down the road and swear to myself that I'd never become like that. </span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">Peter survived the surgery and was transferred to the
pediatric ICU, where he remained for almost a week in critical condition. His
family slept at the hospital, staying at his bedside as much as they could.
Pastoral care and social workers did their best to help the family manage their
feelings and help them with all of the little things that need to be addressed
when a loved one is critically ill. Peter's intracranial pressures actually
slowly began to improve, but he then began to require mechanical ventilation to
breath adequately. His hospital course was complicated by one of his lungs
collapsing, a lung infection, a deadly respiratory distress syndrome that
sometimes occurs after trauma, and eventually progressively worsening blood
pressures. </span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">Finally, late in the afternoon on what would be his last day in the
hospital, Peter's status was continuing to worsen. After one final flurry of a
failed resuscitation attempt, his father decided that it was time. One more
round of drugs was given in a futile attempt to prolong his life until another
family member could arrive, but Peter died around 6:30 pm that evening before
they got to the hospital.</span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">Several weeks later, I'm now nearing the end of my surgical
rotation. After the end of the fourth week, we switched services and I was
assigned to surgical oncology. This has been another busy service with some
very sick patients, not all of whom have survived the surgeries that were meant
to be a last attempt at a cure. Some of those who have survived still don't have
long to live – maybe a couple of years at best. </span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">I'm still tired. That seems to be a defining feature of
this rotation and probably won't go away with the next one. But my experience
that night at Peter's bedside has stuck with me. It taught me how easy it is to
lose the "bright-eyed and bushy tailed" optimism that so many of us
start third year with and gave me a little more understanding for those weary
residents and attendings who, from my relatively rested point of view as a
medical student, were maybe a bit shorter or seemingly uncaring with patients
than I would like to think I would be. But for all I know, perhaps I'd be even
worse if I was in their shoes. I hope not. To you, the reader, perhaps this all
seems a bit silly and blown out of proportion. And perhaps you're not wrong.
For my own part, though, my hope is that this experience serves as a reminder
going forward to continue to reflect on my "spirit" as a medical
professional and ensure that it doesn't get beaten down by the rigors of the
path to come. </span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<i style="mso-bidi-font-style: normal;"><span style="color: black;">The Verdict</span></i></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">So will I go into surgery? Probably not. That being said, I
really did enjoy the rotation. I think I would be happy in a surgical field,
but then I’d be happy in most fields of medicine. There’s definitely an
important distinction to be made between being satisfied with your career and
being satisfied with your life in general – notably, the former doesn’t
necessarily beget the latter. </span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">I really enjoyed a lot of things about this rotation. I
enjoy working with my hands. I enjoyed the (mostly) definitive fixes that we
were able to offer patients most of the time. I would imagine that being the
person who reached inside someone and fixed them is an immensely satisfying
thing. </span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">But. </span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">I also hated the rest of my life during this rotation. Most
everyone that I worked with seemed to not enjoy (or, perhaps more accurately –
not be able to enjoy) their life outside of the hospital. I’m all for working
hard, and there’s a small part of me that would go into surgery just because I
like to do hard things. But most of those who go into surgery seem to have a
rather unique mentality – the training demands that those who would wield the
scalpel not only be willing to work themselves to the bone but enjoy doing so,
and then come back and ask for more. It demands that those who aspire to be a
surgeon give everything that they have to that end. It demands that surgery be
the most important thing in their life, regardless of the cost to everything
else they might value. At least, that’s what it seems to take to be a “good”
surgeon. And while all of that sounds noble and good, it has a not-so-subtle dark
side. </span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">One resident that I worked with has a wife, a two year-old
child, and one on the way – a similar situation to myself. I was trying to pick
his brain about how this all worked during his busy residency. His response
was, “It’s fine. My wife [she worked nights as a nurse] picks our kid up from
daycare on her way to work in the evenings and drops her off at a friend’s
house. I pick her up from there on my way home from work and put her to bed. In
the morning, I’ll take her back to her friend’s house on my way to work, and
then my wife will pick her up from there and drop her off at daycare for the
day. We may not see each other for a couple of days, but that’s fine. It works.”</span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">No. That’s not fine. At least not for me. Being a good
doctor is important to me. It’s an incredible profession that demands a lot of
its trainees, regardless of what field they go into – and rightly so. I’m more
than willing to work hard. But there’s more to life that being the “best doctor
ever” or proving to your colleagues that you can take endless amounts of abuse.
I value my future career, but I also value being a good husband and father, one
who can be present in and participate in my family’s lives. I have interests
outside of medicine that are important to me as well. </span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">There are certainly those who balance a surgical field with
all of the above and do it well. But there are very real costs to such a path
that need to be counted before one enters onto it. Particularly when you are
entering a field where certain residency programs used to actually boast of
divorce rates greater than 100%, you have to understand that you are fighting
the tide when it comes to maintaining a healthy family life during your
training. Sure, residency and fellowships are temporary, but that’s still five,
six, seven years of your life. And most of the attendings that I worked with
didn’t seem to slow down much themselves. </span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">One piece of advice I’ve heard is, if you’re thinking about
going into a field, try and identify someone in that field who is living the life
you hope to live when you get to where they are. If you can’t find that person,
it probably is for a good reason. For me, I was just trying to find someone who
was able to spend enough time with his or her family. I had the opportunity to
work with a pretty large number of attendings, but most of them either 1) had
very young families (i.e. didn’t start a family until after most or all of
their training was done and they were established in their career) 2) were
single 3) saw their families “enough” for them (e.g. “I saw my kid once this
week – that’s enough for me”) or 4) seemed like they were always working and
bemoaning not being able to make it home for planned events or whatever. </span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">Some people get into the OR and feel that they’ve found
their home. That wasn’t my experience. As I said, I certainly enjoyed it. But I
won’t really miss it all that much. And therein lies the important decision
point – if surgery turned out to be “the one thing” in medicine that I truly
enjoyed, then we would consider starting down that path. It would be difficult,
but we would without a doubt come out the other side stronger for it. But the
stuff that doesn’t kill you, while it makes you stronger, also leaves scars.
Those scars can run deep, and at least for me and my family, they aren’t worth
it. </span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">I guess I’m writing all of this because I really had to
think quite a bit about what I was hoping to get out of medicine and life in
general during this rotation. There were a number of times where, after having
the opportunity to do something “cool” or see some incredible anatomy that I
could peer into the future and see myself doing this. But there were also
plenty of times where I missed out on some special moment with my son or some
quality time with my wife because I was at the hospital during all hours of the
day (or night), and when I was at home I was exhausted and not truly there. </span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">As I said, to some degree that’s just part of medical
school and residency in general, and those features are by no means unique to
my surgical rotation – I’ve experienced busyness and fatigue throughout third
year. But the mentality of the field is different – in other rotations, working
long hours or missing out on stuff happening outside the hospital was a
begrudgingly accepted part of training. No one liked it, but it was
acknowledged as being a necessary part of becoming a doctor. During this
rotation, though, that type of stuff was almost worn as a badge of honor. That’s
just not me. </span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0in;">
<span style="color: black;">I have a lot of respect for those who go into surgery, and
I hope this post doesn’t dissuade anyone who truly is meant for that field (I
doubt that it would). But for those who are reading this who might already have
a family or are planning on starting one soon, I think it’s certainly worth
taking a step back before plunging into the field and counting the cost. For
some, it may be worth it – and rightly so. The field of surgery is varied and
incredible. For those like me, though, who could have a satisfying career in
many different areas of medicine, it might be worth thinking twice before
committing yourself to that path. </span></div>
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="table of figures"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="envelope address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="envelope return"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="footnote reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="line number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="page number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="endnote reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="endnote text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="table of authorities"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="macro"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="toa heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 5"/>
<w:LsdException Locked="false" Priority="10" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Closing"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Signature"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Message Header"/>
<w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Salutation"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Date"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" Name="Hyperlink"/>
<w:LsdException Locked="false" SemiHidden="true" Name="FollowedHyperlink"/>
<w:LsdException Locked="false" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Plain Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="E-mail Signature"/>
<w:LsdException Locked="false" SemiHidden="true" Name="HTML Top of Form"/>
<w:LsdException Locked="false" SemiHidden="true" Name="HTML Bottom of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal (Web)"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Acronym"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Cite"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Code"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Definition"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Keyboard"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Preformatted"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Sample"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Typewriter"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Variable"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal Table"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="No List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Contemporary"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Elegant"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Professional"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Balloon Text"/>
<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" QFormat="true"
Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" QFormat="true"
Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 5"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 5"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 5"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 5"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 5"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="46"
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<![endif]-->eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com3tag:blogger.com,1999:blog-2365930991142326796.post-3557839096942211062016-01-02T11:27:00.002-06:002016-01-02T11:34:14.360-06:003rd Year Chronicles: Family MedicineMy family
medicine rotation ended about a week and a half ago and I’m now officially
half-way through third year, which is crazy. As preclinical students in our
first two years, I feel like we always heard about how hard third year can be
and how terrible some people’s experiences are as they get into the hospital or
spend more time in clinics. So far, though, I’ve actually had a great time and
have enjoyed third year more than the first two years (which I also enjoyed,
mostly because of the ability to more or less set my own schedule).
<br />
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjKiv2HmV9pEBlpYVDzldLjBr4_gCcAfczAhNa5a8Wifx3nIsWAM9aj-F-sC05hTx1hPd0mCgTSPQ51Bcq55V3wUVWw_FRTAy1ra4UttvTzQMO0GhAhsZctMSPy89H-uHH-OLYDRZQ8IA/s1600/a-spoonful-of-sugar-makes-the-medicine-go-down-funny.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjKiv2HmV9pEBlpYVDzldLjBr4_gCcAfczAhNa5a8Wifx3nIsWAM9aj-F-sC05hTx1hPd0mCgTSPQ51Bcq55V3wUVWw_FRTAy1ra4UttvTzQMO0GhAhsZctMSPy89H-uHH-OLYDRZQ8IA/s320/a-spoonful-of-sugar-makes-the-medicine-go-down-funny.jpg" width="291" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Stolen from <a href="http://www.dumpaday.com/wp-content/uploads/2012/10/a-spoonful-of-sugar-makes-the-medicine-go-down-funny.jpg" target="_blank">here</a></td></tr>
</tbody></table>
Part of
that, of course, is that the “worst” of third year is yet to come. So far, I’ve
completed pediatrics, OB/GYN, psychiatry, and family medicine. With the
exception of OB/GYN, all of these are potentially difficult but overall
pleasant rotations. As we welcome in the New Year, though, I have four months
of surgery and internal medicine staring me in the face. So that should be
interesting. Perhaps I’ll find that I’ve spoken too soon about this whole
“third year isn’t so bad thing.”</div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Hopefully
not.</div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
In any case,
back to family medicine. I completed this six-week rotation at a local family
medicine residency program. This means that I spent a lot of time seeing
patients and presenting to residents. After that, the resident would come say
hi to the patient and then we would go present the patient to the attending
physician. Over the course of the rotation, I also was able to spend some time
in a dermatology clinic, spend some time on the family medicine inpatient
service (I honestly didn’t know this was a thing before this rotation), shadow
a home health nurse for a day (which was an interesting side of medicine I
really hadn’t had much exposure to), and visit a nursing home. </div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Of course,
one of the best parts of the rotation was the hours. Since family medicine is
by-and-large an office-based specialty, the hours were pretty much office hours
– 8 am to 5 pm most days. Which was beautiful. The days generally went by
fairly quickly, too, as there were lots of patients to be seen. </div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<i style="mso-bidi-font-style: normal;">The Verdict</i></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
As medical
students progress through third year and spend some time in various
specialties, we get a chance to try and pick out the things we enjoy (or don’t
enjoy) about each specialty and – hopefully – have at least an idea of what
we’d like to do when we grow up by the end of third year (if not sooner). I was
actually really surprised by how much I enjoyed family medicine. I knew that
I’d likely enjoy it – I’ve enjoyed most of my rotations so far – if only
because I was looking forward to getting back to the broader field of medicine
after my psychiatry rotation. Psych was fun, and I actually found myself
considering the field, but I really missed using my stethoscope. </div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Something
that the family medicine rotation helped me realize is that I enjoy the broader
medical fields. Pediatrics was pretty broad, although I don’t know that I want
to deal exclusively with kids. I certainly see the appeal of being very
familiar with a well-defined and limited (but certainly not small) body of
knowledge (as in psychiatry or OB/GYN), but something like family medicine was
a bit closer to what I envision when I picture myself as a doctor – someone who
is moderately comfortable with the majority of medicine. No one person can be
an expert in everything, which is why specialists are necessary, but I just
don’t see myself being a “knee guy” or a “liver guy” when it’s all said and
done. </div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Does that
mean I’ll do family medicine? Who knows. Emergency medicine is still high up on
my list, but this rotation reinforced why – I like the idea of being able to
handle most things. One doctor I was talking with about career choices said
something to the effect of, “Family medicine and emergency medicine are sort of
on the same spectrum – it’s really just a matter of how bloody you like your
patients.” In particular, emergency medicine’s unofficial motto – “anyone,
anything, anytime” – appeals to me. </div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Of course,
that’s a fairly romanticized way of going about choosing what field you are
going to work in for most of the rest of your life. There are obviously many
other considerations in choosing a field. Time invested in training, hours
worked, <i style="mso-bidi-font-style: normal;">what</i> hours you work, what you
actually do on a day-to-day basis, etc. are all things to think about. Also,
I’ve still got two of the biggest rotations of third year ahead of me, so I
can’t put my foot down now and say exactly what I’ll end up doing. Who knows –
maybe I’ll end up loving surgery (probably not). We shall see. In any case, it should
be a rather… interesting… next eight weeks. Surgery, here I come.</div>
eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com0tag:blogger.com,1999:blog-2365930991142326796.post-21525019359293054402015-11-14T20:13:00.003-06:002016-03-24T19:29:49.749-05:003rd Year Chronicles: Psychiatry<!--[if !mso]>
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<![endif]--><span style="font-family: "inherit" , serif; font-size: 12.0pt;">It saddens me to say
that “psycation” is over. So ends the third rotation of third year. Ah well.</span>
<br />
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="font-family: "inherit" , serif; font-size: 12.0pt;">Psychosis
Is Contagious</span></b></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "inherit" , serif; font-size: 12.0pt;">For this six week
rotation, I spent the entire time at a state-run short-term mental health facility.
If that conjures up a picture of old and slightly creepy-looking facilities,
limited staff (budget cuts, of course), and the occasional co-worker or two
that may have spent a bit too much time in psych facility – well, you wouldn’t
be too far off. It isn’t the place that most people end up when they are sick –
only the really, really sick ones that typically have no insurance. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: blue; font-family: "inherit" , serif; font-size: 12.0pt; text-decoration: none;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: blue; font-family: "inherit" , serif; font-size: 12.0pt; text-decoration: none;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8sJjKP8Azw1-3uuW6sCPouwdJnP2_jpGbDqSyZsTdQSkTY0sUdCaT-sbPUq6QjplfNwUdA37MfzIbpTMB9PrBU8kNMgXcl8FrwhXz3ifWxILFvL9KBK7EADtfqgK6-uRNmAYJH5USUjE/s1600/image.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8sJjKP8Azw1-3uuW6sCPouwdJnP2_jpGbDqSyZsTdQSkTY0sUdCaT-sbPUq6QjplfNwUdA37MfzIbpTMB9PrBU8kNMgXcl8FrwhXz3ifWxILFvL9KBK7EADtfqgK6-uRNmAYJH5USUjE/s1600/image.jpg" /></a><span style="font-family: "inherit" , serif; font-size: 12.0pt;">I will say staff there
were pretty great. Additionally, most of the patients there were very nice and wanted
to be there (ok, well, maybe that last part isn’t so true) to get help. That
said, a large number of patients were really actively sick with whatever
psychiatric condition they had and as a result had fairly poor insight into
what was going on and what needed to happen for them to get better. As a
student, this meant that this was a great site to see people who were actively
psychotic, manic, depressed, withdrawing, or what have you. It’s one thing to
read about this stuff but then spend most of your rotation at a run-of-the-mill
clinic and see people who are generally well-controlled and doing ok. It’s
another thing to deal with this stuff every day for about six weeks, and I
thought it was a great learning experience. </span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "inherit" , serif; font-size: 12.0pt;">The other cool thing
about the psychiatry rotation in general was the fact that we were able to
stick around one place for the duration of the rotation instead of switching
gears every two weeks or so. This really allowed me to get to know a lot of the
staff and patients and play more of a role (at least, as much as a third year
can) in the treatment team. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "inherit" , serif; font-size: 12.0pt;">Psychiatry in
particular is very focused on peoples’ stories. Unlike most other specialties
where diagnoses are made often from lab or imaging studies, in psychiatry you
have to delve into people’s lives with them to sort out what is going on. As
such, it’s probably fitting to include a few here – some shorter, some longer,
some ridiculous, others more mundane, but all memorable and all of which played
an important role in my experience. As I went through the rotation, I tried to
jot down some of the more interesting ones and have included some of them
below. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "inherit" , serif; font-size: 12.0pt;">I should also note that,
while some of the stories are humorous, my intention is to relate some of the
stories that stuck with me for some reason – not to make fun of people for
stuff that happens when they are sick. That said… you can’t make it through
even six weeks of psychiatry without at least being able to appreciate the
humor you encounter.</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="font-family: "inherit" , serif; font-size: 12.0pt;">A
Few Quick Stories...</span></b></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="font-family: "inherit" , serif; font-size: 12.0pt;"> </span></b><span style="font-family: "inherit" , serif; font-size: 12.0pt;">
</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l2 level1 lfo1; tab-stops: list .5in;"><span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">The
very first patient that I saw was being spiritually drained by his
"three baby mamas," which family later told us weren't even
real. He later told us they only came to him when he was sleeping at night
or napping during the day, and that they found him to be
"seductive" because of how he dressed. He was diagnosed with
bipolar disorder – he was actively manic when he came in and actually
improved quite a bit before he left. Even when he left, though, he really
wanted that baby mama thing to be real. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></li>
</ul>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l0 level1 lfo2; tab-stops: list .5in;"><span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">Another
patient was hearing voices. He had come in initially because people were
trying to track him through the computer and hurt his sister, leading him
to destroy the computer and whatnot. But now the voices were telling him
to participate in community meetings and read a lot. So he did - found him
initially with maybe twenty magazines meticulously folded in half on his
bunk. I guess at least those are the good voices. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></li>
</ul>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l1 level1 lfo3; tab-stops: list .5in;"><span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">A
couple of patients tried to have sex. That didn't go over so well. Not
exactly a place ripe for ability to give consent. Also... public rooms.
Enough said.</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></li>
</ul>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l5 level1 lfo4; tab-stops: list .5in;"><span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">There
was one patient that was there when I arrived and left shortly after. I
didn’t know her too well, but she usually just paced around with what
psychiatrists call a “flat affect” and other “negative symptoms” of
schizophrenia (essentially, she displayed very little emotion and tended
to be more withdrawn, but would also just stand and stare at you). I tried
to talk to her, but she quickly became agitated and said she didn't
"want to be your project." Also said she was "trying to
confuse herself." Why, you might ask? Her answer consisted of monkeys
and zebras and jungles. I was confused too. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></li>
</ul>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l3 level1 lfo5; tab-stops: list .5in;"><span style="font-family: "times new roman" , serif; font-size: 12.0pt;">One patient told me “I think you are a Klingon.” </span></li>
</ul>
<ul style="margin-top: 0in;" type="disc">
<li class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l4 level1 lfo6; tab-stops: list .5in;"><span style="font-family: "inherit" , serif; font-size: 12.0pt;">Another patient
came in on PCP. Hit about 5-6 people over the weekend. He was acting up
again Monday morning and put in seclusion. Proceeded to pee all over the
floor, moon the staff that was watching over him, and then write on the
window in the door using his feces. Don’t do drugs, kids. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></li>
</ul>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="font-family: "inherit" , serif; font-size: 12.0pt;">...And
A Few Longer Ones</span></b><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">A little
background for this one. So in the last week, two different things happened in
different areas of the facility. First, one patient was brought into the
conference room with the staff for a meeting to let him know that he needed to
stay a little longer. He didn't like it, blew up, threw a coffee mug at the
doctor (bad aim, fortunately), flipped a heavy wooden table, trashed the place,
and scared everyone. Second, at intake, some dude broke one security guard's
nose, another's wrist, and sprained or broke another guy's arm.</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">That
brings us to today. Similar situation – we had brought a previously psychotic
(found naked on street "running from cops" and paranoid) and still
somewhat manic guy in to let him know we needed him to stay a bit longer. He
didn't like it and became agitated. We herded him out of the conference room (to
avoid a repeat of the previous scenario). I tried to pull him aside and have
him sit down – we had a decent relationship before this. He came with me and
sat down, but as soon as he saw the doctor who said he wasn't leaving yet
again, he jumped up and started posturing and yelling at him – lots of
pleasantries that won't be repeated here. He proceeded to do this for about
forty-five minutes. We cleared the main area, called security, and tried to
verbally de-escalate him. It wasn't working, but security wanted to keep trying
(to avoid situation two). We finally ended up having to grab him, restrained
him, and gave him some emergency meds that calm you down and make you a little
sleepy.</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="font-family: "times new roman" , serif; font-size: 12.0pt;">Shawshank Seizures</span></b><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">We had a
patient that tried to escape a few times. His first try was a little bit after
I left for lectures in the afternoon – he tried to grab a staff member’s key
and make a break for it, attempting to kick down several doors in the process.
Everyone there at the time tackled him, and pretty much everyone was sore or
had a scrape or bruise to show off the next day. Then, the next morning, he
tried to use a chair to break through the winder in his room. That didn't work,
thanks to the shatter-proof glass.</span><br />
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">The real
topper happened a couple of days later. He suddenly seemed to be short of
breath and having chest pain. Now, this guy is in his early twenties, hadn't
had access to any drugs in the past several days, etc. Seemed like he was most
likely having a panic attack (or faking symptoms to get to the ER, where it
might be easier to escape). That seemed to pass, he stood up, and actually fell
down and started seizing. He had about four ~30 second seizures in about
fifteen minutes. We supported him as best as we could while trying to protect
his head and airway. EMS came, took him to the ER, where he finally woke up and
made a break for it. No luck there, though - security caught him, brought him
back to the ED, he eventually returned to the facility. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">The
interesting thing about this guy is that he probably was having seizures. It
turns out that you can have what are called “secondary psychogenic
non-epileptic seizures,” which basically just means that you don’t have a
seizure disorder or any pre-existing focus of abnormal electrical activity in
your brain, but sometimes under severe stress/anxiety/emotionality, you can
actually cause your brain to discharge abnormally and – bam – you are having a
real seizure. Interesting stuff.</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">When Freud is Your Patient</span></b><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;"> </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">In one
memorable two day period, I had patients start to come at me three different
times. The first time was with an old vet with a number of issues who
really didn't want to be at the mental facility (no one does). He
started to raise his clenched fists as if he were about to throw a punch, but
we talked through it. The next two times happened on the same day with
another patient, 50-something year old male with active schizophrenia. We'll
call him Paul. He was actually the patient of another doctor on the unit.
He had been found wandering around some rail-road tracks. No one knew where he
had come from – it sounds like he had a history of being a sexual offender and
some other pleasant backgrounds. We later found out that he had worn out his
welcome at several local nursing homes, and the last one apparently “forgot” to
report that he went missing or something. Hmm.</span><br />
<br />
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">Now, this
guy was extremely disorganized, irritable, and very difficult to understand. He
also was (as psychiatrists like to say) very "sexually preoccupied."
What that actually meant is that he spent his first weekend running around
exposing himself at the nurses' station, masturbating in the common area,
peeing everywhere, and trying to get handsy with some of the female
patients. </span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">So I walk
in Monday morning and see this guy standing right outside the locked door
separating the nurses' station from the common area. Hmm. It's not uncommon for
schizophrenic patients to sort of just stand and stare for long periods of
time, but I hadn't seen this guy before. I walk out into the common area and
try to introduce myself. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"Hello
- what's your name?"</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"(<i>Incoherent mumbling....</i>)"</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"What's
that?"</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"Sigmund
Freud" </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"Oh...ok.... Nice
to meet you." </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"(<i>More
mumbling....</i>)"</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">Hmm.
Alright.</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">That was
our first interaction. Later, I was walking through the common area and he
approached me again.</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"(<i>Incoherent mumbling...</i>)" </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"I'm
sorry, what was that?" </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"(<i>More
mumbling...</i>) ....Freud .... (<i>mumbling</i>) .... dissertation..."</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"...
Are you asking if I know Freud's dissertation?"</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">He
nodded. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"I'm
not familiar with any particular dissertation...is there something in
particular you are wondering about?" </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">That's
where it all went downhill the first time. After that, he just glared at me and
went off on a rant about what I can only guess was about how inept the entire
staff at the facility was. He started to come close to me, and it wasn't in an
"I want to give you a hug" kind of way. I stepped back, but he kept
coming and now I noticed that his left fist was clenched and heading my
direction, as if he was threatening me or about to punch me. That's no
good.</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">What I
should have done at this point was just walked away. Unfortunately,
my first reaction was to make more space and control what I perceived to
be a threat. So I stepped back while placing my hand on his chest and used my
other had to lightly redirected his left fist back to his side. We then
had a fairly nonproductive conversation about how that type of action is
inappropriate and not helping him, etc., and I left (and washed my hands
immediately. This guy wasn't exactly an example of stellar
hygiene). </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">Later in
the day, I was out in the commons area again on my way to whatever my next task
was. I don't even remember what started things this time, but this guy wasn't
too fond of me now. He comes up to me and starts to incoherently mumble rather
aggressively in my general direction. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"Can
I do something for you?" </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"(<i>Angry
mumbling</i>)” </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"...Ok.
I'm sorry, I'm having a difficult time understanding what you are
saying." </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">Now he
steps towards me again and quickly grabs my tie. Nope - that's not going to end
well. I grabbed it back before he did anything and just walked away. He was
just looking for trouble at this point. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">Fast forward
to the next day. Just as I walked in, this patient had hit another patient in
the jaw. Nice. The day after that, I walk in to him getting into it with the
staff because he had stolen some clothes that belonged to another patient and
refused to give them back. We finally convinced him to give them up, but he
almost immediately walks over and tries to take another patient's set of
colored markers.</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"Paul,
you can't take those markers. They don't belong to you."</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"(<i>Mumbling...</i>)"</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"What?" </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">At this point
he mumbled something about how it didn't matter, and wanted to know how much
she paid for them. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"None
of that matters. They don't belong to you, and you can't take them. Go sit in
that chair." </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"It
does matter!" </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">Every
once and a while, a coherent phrase slipped through his "mumbliness"
– that was actually a somewhat encouraging sign. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">We went
back and forth a little bit. I eventually walked away after the other patient
had recovered her belongings to take care of another task, but no sooner walked
back to the nurses' station when I looked back and now Paul was trying to
corner another patient. The other patient slipped around Paul and around a
corner out of sight, presumably into his room. But then Paul followed. Of
course. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">I walked
back out into the commons area and over to that patient's room. Paul was
standing in front of the closed door, tugging at the door handle. I couldn't
tell if he was trying to get in or barricade the door so the patient couldn't
get out. Either way, this wasn't ok.</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"Paul,
stop that. You can't go into other patients' rooms." </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"(<i>Mumbling...</i>)
why not... (<i>mumbling</i>)?"</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"You
aren't allowed in there. You can go into your room, though." I pointed at
his door, just down the hall.</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">At this
point he changes course and starts asking me questions. I make out something to
the effect of "who are you?" and told him I'm a medical student. He
said something about "....study... anatomy... " and I said yes, we do
study anatomy. He then appeared to want to challenge me again and seemed
to ask something about phalanges. I responded with something about fingers and
he seemed pleased. At least I finally got a smile out of the guy. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="font-family: "times new roman" , serif; font-size: 12.0pt;">Shawshank, Part Two</span></b></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">One
Friday, I was sitting out in the common area during my lunch break trying
to study a bit. We had just received a new patient. Now, upon arriving, most
patients' first question was something along the lines of "When can I
leave?" This patient in particular – we'll call him Timothy – did not
want to be here. He came out of his room and started pacing around, talking
about how he didn't need to be here and how he was going to pick up a chair and
smash through the (shatter-proof) glass door leading outside (to a secure
patio) and escape if he didn't get out of here in five days. He eventually
calmed down after a staff member started talking to him and offered to play
ping pong with him.</span><br />
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;"> </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "times new roman" , serif; font-size: 12.0pt;">Fast forward about twenty minutes
down the road. I'm now sitting in the office with
the doctor I'm working with, and we hear a loud BANG BANG BANG
coming from somewhere outside the door. Initially, we thought it was Paul again
– he would get riled up every once and a while about something or the other,
usually about how he wanted a cigarette. I walked outside of his office
expecting to see Paul at it again, but the noise was coming from the side of
the facility opposite Paul's room. Uh oh.</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">We all
run over to the room that the sound is coming from and crack open the closed
door to reveal Timothy using a small bed-side table to repeatedly hit the (once
again, shatter-proof) window in his room. Oh boy. He sees us and starts to
charge at us with a crazy look in his eyes and the table over his head. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">That door
was closed so fast you wouldn't believe it.</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">At this point,
we signaled the nursing station to call security. After a moment, Timothy
realized he wasn't getting anywhere with the table vs. window scenario and
stormed out of his room. He was empty-handed, but didn't exactly look to be in
the greatest of moods. We tried to verbally de-escalate him, but he wanted
nothing to do with it. He stomped on over to the middle of the common area,
picked up a chair, and started throwing it against the door leading to the
enclosed patio. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">Well, he
wasn't kidding earlier, apparently. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">Unfortunately
for him, these doors and windows had been built with this type of scenario in
mind. After a couple of tries at the door, he gave up and ran over to the
nurses' station. Now, the station was enclosed with the same type of glass, but
I guess I figured that body-slamming it might work.</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">It
didn't. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">By this
time, security had finally started to arrive. Once again, they tried to
verbally de-escalate him, and once again, Timothy wanted nothing to do with it.
He continued to be aggressive - making fists, threatening staff, cussing his
heart out, the whole nine yards. After a bit, security realized this wasn't
going anywhere and took advantage of an opening in his tirade to tackle him.</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">Now,
Timothy was a smaller guy, but he was strong. Three big security guys were
having a difficult time just controlling his upper body while he was down, so
the doctor and I jumped in to help hold his legs. We eventually got him back
into the private room for restraints, and after a little bit of scuffling and
spitting (on his part, anyway) finally had things under control. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">The next
Monday when I came in, I heard that he did well over the weekend from the
nurses. That's good. I walked into the common area, saw him sitting in a chair,
and nodded at him to say hello. He glared back at me a little, but nodded in
return. Good enough. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">Later in
the day, I had just finished lunch and went back into the common area to study
a little bit while things were quiet. All the patients were eating lunch. This
one new patient we had who was actively psychotic for some reason had it in his
head that Timothy was out to get him and kept intermittently yelling at
him from across the room. To his credit, Timothy kept his cool and mostly
ignored him. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">Mr.
Psychotic, however, wasn't done. Once he finished his lunch (smart man), he got
up and made his way towards Timothy, yelling all the while. We all started
heading their direction, but Timothy had had enough by this point.</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"I
see where this is going." he grumbled. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">He got up
quickly, took off his jacket, and before you knew it those two were going at
it. Now, most people that fight at this mental facility honestly don't really
even know how to throw a punch. Which is a good thing. But these guys - well,
it obviously wasn't their first rodeo. Once again, security was called. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">We
cleared the other patients out of the common area and circled around Timothy
and Mr. Psychotic. For the most part, we don't have the staff to safely
intervene between two aggressive patients so we just try to keep the other
patients out of the way and only step in between the fighting patients if
someone is really about to get hurt. These two were pretty much just grappling
around on the ground at this point, so we were going to let them do their thing
until security arrived. Timothy, though, was actually doing well in the sense
that he was really just trying to hold the other guy and keep him from doing
anything stupid. He quickly became fatigued, though, and Mr. Psychotic managed
to get him in a headlock. That's no good. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">At this
point, we jumped in and separated them. Security finally arrived after we got
them apart. Mr. Psychotic got emergency medication and restraints; Timothy just
requested some medication to help him calm down. </span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<b><span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">Does Somebody Need a Hug?</span></b><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;"> </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">On my
last day, the staff all pitched in and brought various breakfast items to the
morning meeting. It was very nice of them and it was really a pleasure to work
with them all. At one point during to the day, though, I hear a commotion
coming from the doctor's office off of the common area. Paul had somehow
managed to get into the office and was refusing to leave, despite a tech's
urgings. He sat down in a chair in the office and refused to move.</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">"I'm
a doctor! I'm a psychiatrist!" he slurred.</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">Oh, Paul.</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">This tech
had had enough. Paul had been in rare form all morning, and now
he had bought himself a ticket to seclusion. The tech was determined
to get him there. She pushed Paul in the chair he was sitting on all the way
across the common area. It actually worked to get him into the back hallway,
but then he plopped down onto the floor. Now, he had done this before. He would
just lay down in some inappropriate place and just stay there, but he couldn't
stay here and he knew it. He latched on to another tech's leg with a death grip
and refused to let go. I got in there, pried his hands off, but then he latched
on to my leg.</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">(At this
point, he started to untie my shoe with his other hand and start mumbling about
how they were his shoes or something. Oh, Paul...). </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">He was
just lying there at this point, latched on to me. I had him just stay there
until security got there and while we administered some emergency medication,
then extricated myself again from his death grip. But not to be outdone, he
grabbed on to a nearby chart rack and shoved his head under it. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<i><span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">*sigh*</span></i><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">We sort
of all stood around him rather perplexed. Come on, man, really<span style="font-family: "inherit" , serif;">?</span> </span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">Finally,
we pry first one hand ("Got it! Here hold this arm.") and then the
other ("He's free! Pull him out!"). We tried to bring a wheelchair
back, but ended up just carrying him back to the seclusion room.</span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">I'll miss
you too, Paul. I guess he just wanted a hug. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<i><span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">The Verdict</span></i><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">I don’t
see myself going into psychiatry, but I was surprised by how much I did really
enjoy it. I think I would miss more conventional “medicine” too much. Also, I
was surprised by how mentally draining it was. This may have been a bit unique
to the environment I was in, but unfortunately really sick psychiatric patients
tend to have very little insight into their illness and the fact that they
really need treatment to get back on their feet. This means that, for most of
their 5-10 day stay with you, you are repeatedly trying to convince them to
take their medication and meet with their therapists and whatnot. Sometimes
people do amazingly, turn around, and have an amazing recovery. But you’ve
still been fighting with them for the previous week and a half to get them
there. Additionally, some patients are so sick or have been sick so many times
that their level of functioning is markedly reduced (like Paul). While
occasionally encounters like these can be entertaining, it’s usually just
really tiring and more importantly pretty sad for the patient. All of this sort
of combined to make this rotation particularly mentally and emotionally
demanding, which I wasn’t really expecting. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">That
said, it’s an awesome field with many discoveries yet to be made. It’s probably
actually somewhere on my list of possible specialties now (I really wasn’t
considering it at all before), albeit low on that list (as in, if absolutely
nothing else in the rest of third year jumps out at me, I might consider psychiatry).
The people who go into psychiatry, especially a lot of the newer residents,
tend to be awesome and fun to be around. It’s also a field where you can
achieve a pretty decent work-life balance – at the risk of sounding like a
whiny millennial, my family is important to me and while I’m all for working
hard while you are at work and working particularly hard over the next few
years and during residency, afterwards I’d like to be able to not spend every
waking moment in the hospital. </span><span style="font-family: "times new roman" , serif; font-size: 12.0pt;"></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="color: black; font-family: "inherit" , serif; font-size: 12.0pt;">My next
rotation will be family medicine. It’ll be an adjustment going back to more
“regular” or conventional medicine, but I’m looking forward to it. I’ve heard
good things about the site I’ll be rotating at – it should be very interesting
and a lot of fun.</span> </div>
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="35" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="10" QFormat="true" Name="Title"/>
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="1" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
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<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
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<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
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<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
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<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
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<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
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<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
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<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
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<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
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<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
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<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
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<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
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<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
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<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
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<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
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<w:LsdException Locked="false" Priority="21" QFormat="true"
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<w:LsdException Locked="false" Priority="31" QFormat="true"
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<w:LsdException Locked="false" Priority="32" QFormat="true"
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<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
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<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
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<![endif]-->eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com2tag:blogger.com,1999:blog-2365930991142326796.post-18906375515743558562015-10-03T10:43:00.001-05:002015-10-03T10:43:35.628-05:003rd Year Chronicles: Pediatrics and OB-GYN<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: left;">
<span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 107%;">Third
year has officially started. Well, it officially started a few months ago. I’ve
actually finished two rotations so far and am currently on a week-long (and
glorious) fall break.</span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 107%;"><b>I
Finally Get to Hang Out with My Peers</b><o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmjHsmCrDUh3BAGiPXCe7I_EU-Z6XiRJuMNKKfuVOy4APNlKhDK9_gzcOLPiYBH_SWrFyfI2wUGEyMcwLqmgwkhPL1m9thXLCexpMwNs3OEJOHW2jsSrwiux-NQYz1esZFKmBhmJgNPbY/s1600/picture.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="224" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmjHsmCrDUh3BAGiPXCe7I_EU-Z6XiRJuMNKKfuVOy4APNlKhDK9_gzcOLPiYBH_SWrFyfI2wUGEyMcwLqmgwkhPL1m9thXLCexpMwNs3OEJOHW2jsSrwiux-NQYz1esZFKmBhmJgNPbY/s320/picture.jpg" width="320" /></a></div>
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 107%;">The
first rotation of the year was a six-week stint in Pediatrics. Some of the
details of the rotation varied from student to student depending on how the lottery
for the various sites worked out, but I spent two weeks in an outpatient
clinic, one week on peds ER night shifts, one week on nursery, and two weeks on
the peds inpatient service. </span><br />
<div style="text-align: right;">
</div>
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 107%;"><o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 107%;">The
outpatient clinic happened to fall around the tail end of summer, which meant I
saw a lot of healthy kids for well-child checks and back-to-school sports
physicals. Which is awesome – healthy kids are always a good thing – but it
meant that the interviews and exams were getting a bit repetitive by the end of
the second week. I did enjoy getting a peek into the long-term relationship
that the physicians I was working with had with the families they saw – often,
they had seen these kids that were now heading off to college since they had
been in diapers. That was appealing to me in some ways, which is something to
consider for future career choices. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 107%;">The
week of nights in the pediatric ER made up for the monotony of the outpatient
clinic. I worked with a few different pediatrics residents overnight as they
were rotating through the ER. One of the residents I worked with had a viral
gastroenteritis and spent the better part of the first half of her shift hiding
in the bathroom. Instead of going home, though, she grabbed a nurse that was
walking by and asked him to start an IV on her so she could get some fluids.
Two points for dedication, I suppose. Later, we were seeing a 17 year old male
that had avulsed the nail of his right middle finger while playing hockey (it
was puck vs. finger – through a glove, too). With the ER attending, she was
trying to put a digital block in that finger, but was shakily heading the
needle in the direction of the wrong finger. Thankfully, the ER attending
smoothly redirected the needle towards its intended target without saying a
word. Go home when you’re sick, folks. It was pretty cool to watch the
attending complete the nail removal, suture an underlying laceration, and
dermabond the nail back in place as a sort of natural bandage. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 107%;">Also,
I got to “fix” a patient. A 15 year old male came in with his mom complaining
of a foreign body sensation in his left eye that started suddenly after he “flicked”
his T shirt up at 2 am in the morning while looking at his phone (yep). I
lifted his eyelid to examine him, had him move his eyes in a few different
directions, and he suddenly smiled and said “It fell out!” Medical student to
the rescue. Still got to do a fluorescein exam, though, which was fun. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 107%;">After
the ER, things slowed down a bit when I moved to the nursery. This was actually
a lot of fun – what better way to spend the day than hanging out with a bunch
of happy parents and new babies? We also rounded with the NICU team in the
mornings, which was a bit less fun. The advancements in medical technology and
our ability to keep severely preterm babies alive is remarkable, but that doesn’t
make it any less difficult to see two-pound babies on CPAP machines. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 107%;">The
pediatrics rotation ended with two weeks on the inpatient service. I was
actually surprised by how much I liked the pace of inpatient medicine (although
my perspective was admittedly a bit skewed as a medical student). We actually
had a pretty nice schedule – showed up around 7 am to pre-round on a few
patients, write progress notes, round again with the team around 8:00-8:30 am, take
care of whatever business needed to happen in the morning, have lunch, then
spend most of the afternoon in an impromptu lecture, see new admissions, or study.
We typically finished by 3:30 pm, which was awesome (unless we had call, in
which case we stayed later into the evening). <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 107%;"><i>The
Verdict</i><o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 107%;">Overall,
I really enjoyed the rotation. I don’t see myself going into pediatrics, but I
really enjoyed certain aspects of the field. The final test at the end was
actually pretty difficult – since it’s such a broad field, there was a lot of
information to cover. Loyola uses the MedU pediatrics final, so we had the
associated cases to complete during our rotation. I did those and most of the
UWorld questions, and it seemed to work out fine on the test. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 107%;"><b>The
Part Where I Deliver Placentas </b><o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 107%;">After
peds, I jumped into OB-GYN. It was actually nice to have these two rotations
back-to-back, since there is a little bit of crossover in terms of the
knowledge base you need to acquire and it helps to hit the ground running in
OB-GYN with the peds stuff down pat. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 107%;">I
started off with two weeks in Labor and Delivery. This was probably my favorite
part of the rotation – I felt like I learned a lot and really enjoyed the residents
that I worked with. The hours were a bit longer than peds – throughout OB-GYN,
the days usually went from around 6 am to 5-6 pm – sometimes starting or ending
a bit earlier or later, but that was the gist of it. This was also the part
where I delivered placentas during vaginal deliveries and where I got to see my
first cesarean sections up close and personal. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 107%;">For
the second two weeks, I moved to a service called “Benign Gynecology.” This was
basically a mix of clinic, surgery for “benign” things (like hysterectomies,
cystectomies, hysteroscopies, etc.), and following any general GYN patients on
the inpatient side of things. It would have actually been an enjoyable part of the
rotation if not for also being the rotation where I worked under a rather…
interesting intern. This particular intern will one day be an excellent
physician and teacher, but at the moment is still trying to find her feet and
seems to be channeling a lot of that frustration towards the medical students
under her. She has very high expectations of herself and others, which is
awesome, but did a poor job of communicating those expectations to us. Which
meant that the entire two weeks was essentially a never-ending game of “guess
what I’m thinking.” We as students did the best we could, but we all were
incredibly relieved to finally get off that service. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 107%;">OB-GYN
ended with two weeks on the Maternal-Fetal Medicine service – these are the
guys and gals who manage high-risk pregnancies – those with problems with the
fetus (e.g. congenital issues) or with mom (chronic diseases, diseases related
to pregnancy, etc.). It was mostly clinic – three days a week were spent doing repeat
visits for current patients, and two days were spent seeing new patients and
consults. Honestly, the rotation itself was enjoyable but the best part was
working with normal people again and being off of benign gyn. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 107%;">One
of the patients I was following on the MFM service was a very pleasant lady who
had ruptured her membranes early at 31 weeks gestation. She was in the hospital
for observation and treatment and was now coming up on 34 weeks. At that point
in her scenario, the risks of staying pregnant exceed the risks of preterm
delivery. The plan was to induce her right at 34 weeks, which happened to fall
on a day when I wasn’t at the hospital. Another medical student on Labor and
Delivery was there, though, and told me about what happened. He had followed
her for the induction process and helped with the delivery. Just before the
baby came out, though, he had to leave the room to take care of another issue
that kept him busy for a little while. When he came back, the hallway was
quiet. Blood was everywhere in the patient’s room, and the husband was standing
amidst the mess, crying by himself. The student rushed back into the OR to find
out what was going on – it turns out, the patient had a condition called
placenta accreta.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 107%;">The
placenta normally implants sort of superficially into the inner layer of the
uterus, but in some cases, it goes too far. It can invade into the uterine
muscle or even penetrate through the uterus into surrounding structures, like
the bladder. Ultrasound during pregnancy can sometimes pick it up, but not
always. When it does, delivery is usually performed by cesarean section and
followed by a hysterectomy – there’s no way to normally deliver the placenta
without causing massive blood loss. In this case, her placenta accreta wasn’t
visible on ultrasound. The patient ended up losing about 4.5 liters of blood
(the human body only holds about 4-6 liters), but thankfully they were able to
quickly get her back into the OR, control the bleeding, perform an unexpected hysterectomy,
and replace her lost blood. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 107%;">A
couple of days later, I had a free moment and ran by her room to see how she
was doing. She was amazingly very positive, though understandably emotional –
she was overjoyed to be alive and have a healthy baby, but obviously wasn’t
planning on losing her uterus or coming that close to losing her life. Other
people had talked with her about what happened, but she still had some
questions and really just needed someone to talk to. One of the best parts of
third year is that, in some ways, you are starting to become a part of the team
and can actually begin to (cautiously) answer some of those questions, but you
also have the time – sometimes – to just sit with your patients and spend more
time with them than some of the more senior team members can (since they are
busy putting out fires that never cease to get started). This was one of those
times, and she’s a patient I’ll definitely remember.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 107%;"><i>The
Verdict</i><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 107%;">I
don’t see myself going into OB-GYN. Once again, I enjoyed several aspects of
the rotation. It really is a pretty cool mix of surgery, primary care, clinic
visits, and inpatient medicine. There’s a lot to do and a lot of very distinct
fellowship opportunities. I didn’t think the test was quite as brutal as the
Pediatrics final exam – we took an NBME shelf and I felt like the UWorld
questions and the Case Files book, along with reading Up-to-Date and various
articles throughout the rotation, was sufficient. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 107%;">One
thing that was interesting was just the simple fact that this was the first
true “specialty” I rotated in. Pediatrics is a specialty, yes, but it’s
essentially medicine for little people, which means it’s a very broad field. OB-GYN,
on the other hand, has a definite knowledge set that those who pursue the field
become experts in. I think that appeals to a lot of people (not about OB-GYN in
particular, but about niche specialties in general), but I’m think I’m the type
of person who would rather know a moderate amount of information about a broad
range of topics (e.g. internal medicine, emergency medicine, family medicine,
some surgical fields, etc.) rather than know a lot of information about a
particular slice of medicine. We shall see.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 107%;">In
the meantime, though, I’m thoroughly enjoying a week off with my little family.
Our son is almost a year and half now and is getting into all kinds of trouble.
It’s awesome to see him figure out who he is and develop his own personality,
interests, and sense of humor (like sitting on dad’s face. Apparently that’s
the funniest thing in the world…). This Monday, I start psychiatry. The site
that I have is known to be a bit of a true crazy house and also has pretty
decent hours, from what I’ve heard. Should be a nice change of pace. <o:p></o:p></span></div>
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eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com0tag:blogger.com,1999:blog-2365930991142326796.post-35740686025220215742015-07-18T15:41:00.002-05:002015-07-18T16:10:05.017-05:00Step 1 AftermathFirst off, to the kind soul who tried to leave a lengthy, encouraging
comment recently on the “How to Study in Medical School” post and perhaps was
wondering why it didn’t show up: I think I accidently deleted it. Sorry. I did
see it and appreciated your words, though.<br />
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<o:p></o:p></div>
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<tr><td class="tr-caption" style="text-align: center;">This has nothing to do with this post</td></tr>
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As the title suggests, Step 1 is over (!!!) and I’ve started third year. I had planned to write up a “How to Study for Step 1” type post, but I think a post like that would be misleading. There isn’t one best way to study for Step 1, just like there really isn’t one best way to study for medical school. That said, I feel like a “How to Study in Medical School” post (<a href="http://www.dysgraphicmusings.com/2013/11/how-to-study-in-medical-school.html" target="_blank">like this one</a>) is a bit more helpful because it’s such a different beast than anything you’ve done before. Step 1 is too, to some degree, but by the end of two years in medical school you should have a fairly good handle on what works for you and what resources you like. </div>
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So there isn’t one prescription for an awesome Step 1 score. That said, as I was planning my study schedule out, I found it helpful to read about what other people did, found helpful, or had success with. Also, even though there isn’t necessarily one way of doing things, there are definitely some common resources and themes that lend to success on what might be one of the most important tests you ever take. With that in mind, I’ll try to give at least of a rough sketch of what I did below.<br />
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<b>Laying a Foundation</b><br />
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The first thing I’ll say is that probably one of the most helpful
things you can do to get a solid score on Step 1 is lay a good foundation for
yourself in the first two years of medical school. Don’t get too caught up in
what’s “high yield” or whatever. You just don’t know what matters and what
doesn’t, especially in first year and into the beginning of your second year.
There were things that showed up during my dedicated study period that I
remember seeing in first year and never really thought I’d ever see again. So
just do your best to do well in classes. I know some people go to schools where
they feel like professors mostly just drone on about their research, but by and
large medical education across the U.S. is fairly standardized, at least more
or less in terms of essential content. <o:p></o:p><br />
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<b>The Resources</b></div>
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Outside of class material, there are some tools available during your
first two years that might prove helpful. I’ve written extensively about using
Anki to make flashcards. Some people who like the idea of flashcards but don’t
want to make them have liked Firecracker. First Aid is helpful to at least look
at along with your classes, just to see what might be particularly important
and get familiar with how it’s laid out, but more so in second year. Pathoma
for pathology and Sketchy Micro (I guess now it’s called Sketchy Medical) for
microbiology (and maybe soon for pharm? That would be sweet) are absolute gold.
Some people (I’m one of them) enjoyed listening to Goljan audio during second
year and/or during their dedicated Step 1 study period while working out or
driving. Some people like doing question banks during second year. I just didn’t
have the time. <o:p></o:p></div>
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Experiment with what’s out there. There is a lot. By the middle of your
second year or so, start nailing down what resources you are likely to use for
your dedicated period. Don’t try and do too much. I feel that it’s better to
have a handful of resources down pat than to stretch yourself too thin. <o:p></o:p></div>
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Personally, I ended up using First Aid, Pathoma, Sketchy Medical, and UWorld
during my dedicated study period. I had used all of these except for UWorld
throughout second year. During the year, I tried to make Anki cards with most
of First Aid content and Pathoma along with some class stuff, and had watched
most of the Pathoma videos at least twice by the time the dedicated study
period began. I decided not to keep using Anki through my Step 1 period. It had
served its purpose, and I felt like I wouldn’t have enough time (and that
turned out to be true). I also used a website called Cramfighter to plug in my
resources and spit out a study schedule for each day – it was pretty awesome,
and I highly recommend it. <o:p></o:p></div>
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<b>A Day in the Life</b><br />
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My dedicated study period was five weeks. I felt like four was a bit
too short, but six weeks was long and I wanted to maximize my vacation time afterwards.
Five weeks ended up being perfect for me. Before second year ended, my school
provided everyone with an NBME practice exam (Form 12), and I scored 215. <o:p></o:p></div>
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Our last final was on a Thursday, we had a long weekend, and then I got
to it on the next Monday. For the first four weeks, my goal was to get through
everything once. My day started typically around 6 am. I’d exercise while
listening to Goljan audio, shower, eat breakfast, and get started with UWorld
questions around 8 am. This would take the bulk of the day. I’d do two blocks
of 46 questions (until they changed the max to 44 to match the new change in
Step 1) on random timed. One note about that: some people like doing questions
by subject or in tutor mode. It doesn’t matter. Pick what you like and what you
think will serve you best. I liked random timed because 1) that’s how the test
is and 2) by this point you should have at least seen everything in the first
two years, so it’s not like you’ll being seeing stuff that you’ve never seen
before (for the most part). Also, it let me see things several times over
throughout the study period – that repetition is important for me. <o:p></o:p></div>
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I’d do the two blocks, which would usually take about an hour and half
or so. The next 4-5 hours would be spent reviewing all of the questions,
reading all of the explanations (read at least the educational objective for
each question, even the ones you got right. For most questions, I’d also read
at least the expanded explanation. If you’re feeling frisky, read the
explanations for each of the answer choices). For questions I missed or
concepts I wanted to see again, I’d keep a running list for each test in OneNote
where I would put explanations, pictures, graphs, etc. This was probably one of
the more important things I did. I’ll talk a little more about it later. I kept
First Aid nearby while reviewing, and made myself physically turn to the page
that dealt with whatever question I was on, regardless of whether I got it
right or wrong (if you have an electronic copy, word searching for the page you
need makes this a lot faster). Repetition is the mother of learning. <o:p></o:p></div>
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After I finally finished UWorld stuff for the day (usually between
1:30-3 pm), I would read First Aid. It was usually about 30 pages a day, and I
took my time getting through it. First Aid is not a thorough text. It’s more of
an outline. If you didn’t lay a decent foundation during the first two years,
it will seem like gibberish. If you did, though, you’ll be able to read through
it and be reminded of things you learned before. This is when I also watched
Pathoma videos. <o:p></o:p></div>
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Around 6 pm, I’d call it quits for a couple of hours and hang out with
my wife and son, eat dinner, put my son down, etc. Some nights I’d take a bit
more time off, but most every night I had some stuff to finish up. I usually
watched at least a half hour of Sketchy Medical videos (probably the easiest,
most efficient learning you will do) and attempted to get through some Lange
pharm cards (I ended up abandoning this halfway through the deck). <o:p></o:p></div>
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To take a quick rabbit trail: for those that have significant others,
the dedicated study period can be a difficult time. There’s really no way
around it. You have a very finite amount of time to prepare for what is
probably the most important test you will take, and endless amounts of
information to memorize. This is probably the most time you will ever spend
studying in your life. Still, though, it’s important to pay attention to those
around you and their needs. Communication, as always, is key. Way ahead of the
start time of your dedicated period, be sure that you are talking with your
significant other about what’s coming up and what it might look like. Err on
the side of overestimating the time Step 1 will require from you here, at least
to some degree, so that if you end up having more time, it will be a pleasant surprise
for both of you since you were both prepared for the worst. Make sure that you
take at least a couple hours each day to spend with your significant other, and
at least one day off each week. And it’s OK to count down the days. It’s always
important that you and your SO aren’t resentful for any reason towards each
other, and that’s especially true during this time. Talk with each other, and
understand that even though you are exhausted at the end of each day, this is
difficult for them too and the world doesn’t revolve around you. This period
will end, Step 1 will be over someday soon, and normality will resume. <o:p></o:p></div>
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Back to an outline of a typical day. The last thing I would usually do each
day is review my running list of wrong questions, both for that day and all of the
previous tests that week. Once a week, I would go back to the previous week and
review all of those (so on week 3 I would review all of the missed stuff from
week 2). This was probably the most helpful thing that I did in terms of making
my weak areas my strengths. I usually finished my day by 11 pm or so.<o:p></o:p></div>
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So that went on for four weeks, six days a week. I took Sundays off and
just hung out with my family. By the Monday of the fifth week, I had made it
through Pathoma, UWorld, and First Aid once.<o:p></o:p></div>
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Tuesday of the fifth week, I took another school-provided practice test
(NBME 17) and scored 245. I took two practice tests in total. I know some
people have this idea that they need to take every test possible on the off
chance a question shows up on the actual test, but my feeling is that the tests
are best used for assessment purposes to see how things are going. You really
aren’t learning much by taking them, and in the dedicated period your time is
best spend learning from your chosen resources. But do what works for you. The
only thing that might be worthwhile is taking two tests back to back a week out
just to get an idea of how exhausting the real thing is. <o:p></o:p></div>
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Wednesday through Saturday of that last week was spent making a mad
dash through First Aid and Pathoma. I had already finished my “take my sweet
time to learn stuff” pass through the material – this was just to see
everything again closer to the test. Each day, I also went through a week’s
worth of missed questions on my running list. I took Sunday off, and the test
was the next day. <o:p></o:p><br />
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<b>Game Day</b></div>
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The morning of the test, I made sure that I was up early enough to eat
breakfast (while reading through the rapid review section of First Aid) and get
to the testing center in plenty of time. I sat in the parking lot for about a
half hour finishing up the rapid review section (I definitely remember seeing
stuff on the test that made me glad I reviewed some of those last-minute
details) before it was time to go in.<o:p></o:p></div>
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The test itself is a marathon. I took at least a short break between each
block to collect my thoughts (or at least zone out for a bit), although the
breaks got longer as the day progressed. I did bring some earplugs, which was
helpful. And keep in mind that you have to go through the whole fingerprint/search/sign
in or out process each time you enter or exit the test room, which takes at
least a couple of minutes. I thought the test itself was harder than the
practice exams, but sort of easier than UWorld – at least in the sense that
there were more first and second order questions and less third and fourth
order ones. <o:p></o:p></div>
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I walked out fairly certain that I at least passed, but otherwise had
no idea how things went. It was hard, and I felt like it was harder as it went
along (although it’s probably just because I was pretty fatigued in the last
few blocks). As the days went on, I became less sure that I passed, but for the
most part didn’t think about it at all for the next few weeks (which is partly
why this post is a bit later than I had intended). <o:p></o:p></div>
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<b>The Aftermath</b><br />
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My final score ended up being between 250 and 255. That’s a little vague,
I know. I’m sort of trying to preserve the few shreds of anonymity that I have
left, but I also know that’s frustrating to read through an entire Step 1
experience just to get to the end and have no idea how it turned out for the
person. Also, since I’ve talked so much about studying in medical school, it
would be sort of anticlimactic if I didn’t at least give an idea of how things
turned out.<o:p></o:p></div>
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So that’s my Step 1 experience. This post has turned out to be a bit
longer than I anticipated. Feel free to email me or leave comments below with
any questions. Good luck. </div>
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<o:p></o:p></div>
eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com6tag:blogger.com,1999:blog-2365930991142326796.post-26758127140778807512015-05-02T21:24:00.000-05:002015-05-02T21:26:19.153-05:00Half MD<div class="MsoNormal">
Well, second year is officially over. I just finished my
last couple of finals on Thursday and now have a three day weekend of glorious
freedom to spend with my family and celebrate our son’s first birthday before
Step 1 studying starts. <o:p></o:p></div>
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It’s crazy how fast our son is growing up. He is definitely
becoming his own little person, and I get the impression he knows more about
what’s going on around him than he lets on at times. This has actually been a
really fun stage – he was cute to look at when he was a few months old, but now
he likes to play in blanket forts, be chased around, roughhouse, roll balls
back and forth on the ground, read books, press weird key combinations on my
computer while I’m studying that change the screen orientation, and generally
stir up mischief around the house. Even though school is busy, you just can’t
beat coming home at the end of a day to a smiling four-toothed little rascal
who wants to backwash in your water and then get chased around the living room.
<o:p></o:p></div>
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I haven’t written much over the past few months. That’s
partly been because second year has been increasingly hectic, but also because
it’s really fairly boring and monotonous. Don’t get me wrong – I've been
enjoying it, and honestly the last few months (with the exception of these past
couple of weeks that we've had various finals) have actually been quite
pleasant – once you hit your stride with regards to studying, everything
becomes pretty manageable (hint – weekly to-do lists are a must!). That being
said, though, each day isn't too different from the last. Wake up, listen to
lectures, maybe work out, study those lectures, make Anki cards, review Anki
cards, tackle any random other projects that have to be taken care of, maybe go
into school for a few hours depending on the day, call it quits around 6 pm,
rinse and repeat the next day. And the next day. And the next day. So there
really hasn’t been much to write about, honestly. That will change come third
year, I’m sure (although time will become even more of an issue, probably. Ah
well). <o:p></o:p></div>
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But for now, we have the long weekend. So far, it’s been a
glorious reprieve. The fun starts back up again on Monday, though. My test is
in June, so I’ll have five weeks to study. I’ll probably write another post
later about my study strategy, etc., once it’s all said and done. For now,
though, I’m basically planning on going through UWorld, First Aid, Pathoma,
SketchyMicro, and the Lange pharm cards. Our school provided a practice test a
couple of weeks ago to give us a baseline of where we are at, which went pretty
well. They’ll give us another one later on, which I’ll probably take about a
week out from the real thing. I know some people are really into taking as many
tests as possible, but my personal feeling is that they are best used for
assessing where you are at rather than wasting time (and money! They are
expensive – about $50 a pop) answering questions that, when you are done, you
don’t even really get much feedback about. Anyway. I could be way off base, but
I’ll write more about that stuff later. <o:p></o:p></div>
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That’s all I've got for now. I may try and get a few short
posts in over the next couple of weeks. Or not. We’ll see how things go. In any
event… see you on the other side. <o:p></o:p></div>
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eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com0tag:blogger.com,1999:blog-2365930991142326796.post-78042322882303334042015-01-10T20:37:00.000-06:002015-01-10T20:37:27.771-06:00Breaking Radio Silence and Career Conjectures <div class="MsoNormal">
Hello there, internet people. It’s been a while.</div>
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Second year has obviously been kicking my butt. In between trying to not fall too behind in school (harder than you might think) and spend as much time as I can with my long-suffering wife and our rapidly-developing eight month old son, life has been particularly hectic these past few months.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhawyRT3z8LQby_zOQK9t0gV9aWOJgBss1T7Q9qh1g9o9F7dCXXEQ9UupvMbCMd_aHdB4t0y6u6uHGKdtOWaDJsk6NPplyBfkmxpqyHlm8AY3Zd7rvNisJA_C7EzmK63AxD_WmtumX-Cf0/s1600/download.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhawyRT3z8LQby_zOQK9t0gV9aWOJgBss1T7Q9qh1g9o9F7dCXXEQ9UupvMbCMd_aHdB4t0y6u6uHGKdtOWaDJsk6NPplyBfkmxpqyHlm8AY3Zd7rvNisJA_C7EzmK63AxD_WmtumX-Cf0/s1600/download.jpg" height="221" width="400" /></a>We just finished our first week back from winter break (which was excellent; albeit too short. One more week would have been awesome…), and school has started back up in full force. It didn’t help that a few lectures were reshuffled thanks to the wonderful Chicago weather (it has literally been <a href="http://www.theguardian.com/us-news/2015/jan/08/america-colder-than-mars-gale-crater" target="_blank">colder than Mars</a> as of late), which made for a couple of particularly busy days.</div>
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We’ve finished up with cardiac, pulmonary, and renal path before break and now are starting gastrointestinal pathology this week, with neuropath after that. In PCM, we’ve been learning EKG interpretation and just started chest x-ray stuff a little before break, which has been interesting.</div>
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I also registered for Step 1 last semester, which was a bit sobering. As of right now, I’ll be taking it in early June. I’m planning on taking five weeks to study for it – six seemed a little long (and it would be nice to have some more time off afterwards before third year starts) and four seemed a bit short for a test that plays a large role in determining your future. In terms of preparation/studying, I’ve been doing Pathoma throughout second year – before we start a block, I’ll watch the relevant videos so I get the “big picture” and an idea of what’s important. Then, as I go through the lectures, I’m making Anki cards out of the relevant Pathoma and First Aid sections, plus random material from lecture that isn’t in those sources but seems important. In my dedicated period, I’m planning on going through Pathoma and First Aid again along with the UWorld question bank, but that’s still somewhat fluid – I’ll update with more about that as the time gets closer.</div>
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Second year has been difficult. It’s not so much that the content is difficult or that I’m struggling grade-wise. It’s more that the sheer amount of constant effort required to stay afloat in the face of a constant barrage of new material (while also balancing school with family and life in general) can be draining after a while. I’ve still been trying to take weekends and evenings mostly off to spend time with my family, other than reviewing any Anki cards that come due and with the exception of the weekends right before tests, but that makes the weekdays pretty cram-packed. If you haven’t seen the “<a href="https://www.youtube.com/watch?v=R5RapBjos3I" target="_blank">Pancakes Every Day</a>” video put out a while back by the students at St. Louis University’s medical school, it’s worth a watch. It describes pretty well the volume of medical school – and how quickly you can get buried if you don’t keep up.</div>
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That said, I’m still enjoying medical school – the material itself is really satisfying and learning more clinically relevant things like exam maneuvers, EKGs, CXRs, etc., keeps things interesting. I’m also incredibly thankful to have my wife and son – they are both an incredible support system (though my son might not know it yet!) and I’m thankful for my wife’s patience and encouragement, particularly on those days that are rougher than others.</div>
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Since this blog doubles as a bit of a journal for me – it’s interesting even now to look back and read posts from a few years ago (including my somewhat cringe-inducing personal statement for medical school) – I wanted to mention that I’m still trying to decide what I want to be when I grow up. I came into medical school thinking that I would go in to Emergency Medicine, and to be honest that’s likely where I’ll end up. I have been trying to explore different specialties, but nothing really seems to fit quite as well as EM does. I’m looking forward to getting better exposure to some of the other specialties in third year.</div>
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One thing about Emergency Medicine that concerns me is the potential for burn out, which can stem from a variety of factors. I think people used to say that EM physicians burned out because, as a young specialty, those who were practicing it weren’t necessarily doing what they thought they would be doing – and to be successful in the specialty, you really do need to have a certain type of personality. And to some extent, that might have been true.</div>
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But it’s still happening. It’s still a concern for physicians today – residency-trained physicians who thought from the get-go that this is what they wanted. I think it is multifactorial – certainly, the shift-work aspect, which is often considered to be a benefit of the specialty (and can be, to be sure), can become a curse when you are 50-plus years old and still working on Christmas day or are unable to bounce back from night shifts as well as you used to. Obviously things vary from group-to-group in terms of how the practice structure is set up and how you progress through the ranks, but there are no guarantees. Also, something that’s somewhat unique to EM is the fact that, while some small groups or the rare larger corporation might provide some satisfaction in terms of how you can take part in influencing the group’s future or practice, all too often some physicians find themselves as cogs in a wheel for large corporations that care more about their bottom line, door-to-doctor times, patient satisfaction scores, and the like than they do about the physicians in their employ or even good patient care. That can understandably be frustrating for physicians.</div>
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There are a lot of great things about emergency medicine. It is appealing to me to be a jack-of-all trades and yet a master of acute medical care. The shift work, despite its negatives, is also nice – I’d rather work 3-4 busy shifts a week and go home than spend 80 hours in the hospital or be on call. The environment suits me well, and it pays pretty nicely to boot.</div>
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<br /></div>
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That said, I’m also considering a fellowship to give myself an “escape hatch” if needed, or at least to mix things up and hopefully keep things interesting. EM physicians recently became eligible to take part in a one-year pain medicine fellowship, which would allow them to work in an office-based settings (read: more predictable hours) in a stable group of physicians and use a variety of procedures and medications to, well, relieve pain. That sounds like a perfect yang to emergency medicine’s yin.</div>
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It can be difficult to get a fellowship spot as an EM physician and I’m not sure how the week-to-week practice of both specialties would play out (maybe 3 days/week of EM + 1 day part time in clinic? Perhaps locum tenens EM as desired + a couple of days in clinic? Who knows…), but it seems like it would provide a nice balance as well as a sustainable option that I could switch over to if I ever desire more predictability and more of an office-hour type job. We shall see.</div>
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Who knows what the future will look like? In the meantime, the week is over and the weekend is here. I’m looking forward to a bit of rest with my wife and son, and we’re all already looking forward to the next break!</div>
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<br /></div>
eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com0tag:blogger.com,1999:blog-2365930991142326796.post-3020993351117636362014-10-11T08:13:00.000-05:002014-10-11T08:13:35.881-05:00Medical School: Round 2<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxScV3liG-7kTLkkK9dUQUDiMtRWzvAro7NxaPXTcWd-5Wr0xe3bDiuYMQc5AlmwVdaAtomLjSjG-fsSJtpPHIVPePJZyIliKGRIWR2c-oelo2xxJ6kvcpEAXQ4OgcL6q22ssJ_F6QnVQ/s1600/Med+School+Round+2+Image.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxScV3liG-7kTLkkK9dUQUDiMtRWzvAro7NxaPXTcWd-5Wr0xe3bDiuYMQc5AlmwVdaAtomLjSjG-fsSJtpPHIVPePJZyIliKGRIWR2c-oelo2xxJ6kvcpEAXQ4OgcL6q22ssJ_F6QnVQ/s1600/Med+School+Round+2+Image.jpg" height="320" width="256" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Image from <a href="http://boxing-ring.blogspot.com/2010/01/classic-photos.html" target="_blank">here</a></td></tr>
</tbody></table>
<div class="MsoNormal">
I’m sure you could tell from the distinct lack of posts over
the past couple of months, but second year has started. In fact, we’re already
about half-way through the semester and in the middle of our week-long fall
break (the existence of which is probably one of my favorite things about
Loyola). Finally, a chance to catch my breath.</div>
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<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
Our pace has essentially doubled compared to first year. For
example, last year we had about one test per month per class, and each test
covered maybe 20-25 lectures. Not too bad, really. This year, though, we've had
a test every two weeks, with each test covering about the same amount of
lectures. So that’s been fun.<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
As I've talked about previously, the first year at Loyola –
especially the first half – is sort of a hodge-podge of classes meant to get
everyone up to speed and then cover some of the fundamentals. We started off
with two classes that ran for about a month covering behavioral sciences and
basic cell biology/genetics, followed by anatomy, and then picked up after
winter break with physiology and added in immunology near the end of the spring
semester. All throughout the year, we had our patient-centered medicine course
(which covered things like patient interviews, basic physical exam skills, and
various other topics that didn't quite fit in elsewhere). <o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
Second year is a bit more systematic. We essentially have
two courses – pathophysiology and pharmacology – that run simultaneously and
complement each other throughout the year. So, for example, right now we are
learning cardiac pathophysiology and also learning the relevant cardiac pharmacology
as we go along. And of course we still have our patient-centered medicine
course that runs throughout the first three years.<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
Although it’s been busier, the actual information has been
quite a bit more interesting. Also, I’ve finally given up on going to classes.
I essentially went to classes religiously all throughout first year, except for
the last few weeks when my wife had our son. This year, though, keeping up on
studying while also making sure that I can take evenings and most weekends off
means that time has become even more of a precious commodity, and the time
spent going back and forth from school, waiting in between classes, etc., could
be better spent. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
So, to try and be a bit more efficient, I purposely put
myself a day behind so that I watch the previous day’s lectures each morning.
The advantage of that is that I can get started a bit earlier than classes
actually would normally start – and thus finish my day earlier as well. So far,
it’s working out pretty well. I usually have to go in once or twice a week or
so for various small groups and things, but that’s fine. <o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
As far as resources go, I HIGHLY recommend Pathoma for
pathology and SketchyMicro for microbiology, at least for the bacteria.
Incredibly helpful. I’m still using Anki – I’m trying to really only make cards
for so-called “high-yield” information. I’m basically converting the Pathoma
lectures into cards, along with stuff from First Aid as we cover it, plus
whatever information from lectures I think is worth including. Hopefully this
will all come in handy for Step 1 – which, really, is not all that far away at
this point. More than that, though, my hope is that this will drill this information
in for the long term. We’ll see. <o:p></o:p></div>
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My son is about five months old now, and really starting to
develop his own little personality. He’s also growing like a weed – he’s a
little over twenty pounds and fitting into twelve month clothes now. Still not
quite sleeping through the night, but hopefully that will come soon. Hopefully.
<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
Although things have been busier, it’s been a good year so
far. I’m thoroughly enjoying the time off with my family, and finally having the
opportunity to catch up on all those little things that get pushed to the back
burner when life gets crazy.<o:p></o:p></div>
eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com0tag:blogger.com,1999:blog-2365930991142326796.post-10722204804120270812014-07-23T22:10:00.001-05:002017-05-10T07:40:45.188-05:00Staying Fit in Medical School<div class="MsoNormal">
Medical school can be a busy time. The first two years can
be managed fairly well if you play your cards right, but as you add things on
top of the basic goal of passing your classes (e.g. volunteer activities,
research, family, or whatever hobbies you might have), you’ll quickly find your
time becomes a precious commodity. To make time for other (often good)
pursuits, we sometimes take shortcuts when it comes to our health – we sleep less,
eat more, and move less.</div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_xVgosrqfhzu1sGbzy9NA4t09LBggTDobVdpRD966PxfnTobl5OfWCyitjDuAculJTVVg4U38V9QnZiWJbSqpA0kDs3JaA2QB3wGCzm-zWqESTlUZwst5Ngh-6Elg3LX3iaW928e7S2E/s1600/images.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="249" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_xVgosrqfhzu1sGbzy9NA4t09LBggTDobVdpRD966PxfnTobl5OfWCyitjDuAculJTVVg4U38V9QnZiWJbSqpA0kDs3JaA2QB3wGCzm-zWqESTlUZwst5Ngh-6Elg3LX3iaW928e7S2E/s1600/images.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Don't do this. Please.</td></tr>
</tbody></table>
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<o:p></o:p></div>
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I’ve lifted weights for a few years now, but before medical
school I usually worked jobs that kept me pretty physically active on top of
just lifting. That translated into not really having to worry much about, for
example, what I ate – I could pretty much down whatever I wanted and top it off
with two large bowls of ice cream lathered in chocolate syrup and be fine.
While that was a blessing (obviously – ice cream is delicious), it also turned
out to be a somewhat of a curse. When I got to medical school and suddenly
became quite a bit more sedentary, I started to put on a bit of weight. Nothing
outrageous, and it wasn’t all of the sudden. I continued to regularly lift, and
for a while I told myself that I was just getting “bigger.” But my lack of attention
to my food intake caught up with me, and my waistline started to grow.
Suddenly, I wasn’t fitting into my clothes quite as well as I used to. Before long, I was over 190 lb. at about 5 ft. 9 in. and around 22% body fat.
Not good. <o:p></o:p></div>
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<b>Time for Change</b><o:p></o:p></div>
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<br /></div>
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Before I go any further, I want to take a second and say a
couple of things. First, if you are looking to get healthier, that’s great. I
personally want to be around for a lot of years so I can spend a lot of time
with my wife and family, and want to be able to not get tired out after just a
few minutes of wrestling with my son when he is older. Additionally, something
like strength training just has a lot of carryover to real life – things that
run the gamut from being able to lift heavy things to help friends move,
carry in the groceries, or protect my family if the need ever arises. The
desire to lose weight, on the other hand, might stem from wanting to improve
your various lab profiles, reduce your risk for cardiovascular disease (a big
one for me, since I’ve got a pretty strong family history for it), or reduce
your risk for all of the other diseases that come hand-in-hand with an
expanding waist line. <o:p></o:p></div>
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<br /></div>
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So if something along those lines is providing you with the
intrinsic drive you need to eat less and move more, that’s awesome. However,
some people take this whole fitness thing way too far. Being “fit” should not
become your identity or sole purpose in life – it’s a means, not an end. Also,
don’t be ridiculous about things. Sometimes you might miss a session to hang
out with family, or will eat “bad” food when you are out with friends.
Whatever. Don’t freak out about it. Enjoy it. While you obviously don’t want to
eat crap all of the time, every once in a while (and probably more often than
you think), it’s perfectly fine. So relax, and enjoy life a bit. And whatever
you do, do NOT go around telling people how they can be healthier, or what they
should and shouldn’t eat. I know people like that, and it’s not helpful or
pleasant at all. Changing your lifestyle is a personal decision, and if someone
actively wants your help, then by all means help them – but don’t force anything
on anyone.<o:p></o:p></div>
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<b>Ok. So Now What?</b><o:p></o:p></div>
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<br /></div>
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Alright, so back to my waistline. I knew things needed to
change. So I started doing a little research. Here is a brief summary of what I
found.<o:p></o:p></div>
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<b>Losing the Chub</b><o:p></o:p></div>
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<br /></div>
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First off, you have to get something straight – the most
important determinant of how lean you are, or even how muscular you are, is not
how much “cardio” you do, how much weight you lift (although lifting is
important – more on that later), whether or not you eat gluten free, paleo,
your micronutrient profile, or whatever. The single most important determinant
of your body composition is simply your energy balance – in other words, the
calories you take in vs. the calories you expend. <o:p></o:p></div>
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If you want to lose fat, then you have to eat less. <o:p></o:p></div>
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<br /></div>
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If you want to gain muscle, then you have to eat more and
provide the proper stimulus (e.g. weight training). <o:p></o:p></div>
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<br /></div>
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You can stop reading now if you want. That’s really how
important that concept is. <o:p></o:p></div>
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<br /></div>
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All of the common diets out there – low carb, paleo, Zone,
Atkins, Weight Watchers, or whatever – all work. At least for a
while. Why? Because in one form or another, they get you to eat less. That is
really the crux of the issue when it comes to losing weight. Cutting out carbs,
for most people, cuts out a significant food group and thus removes a lot of
calories from their daily intake. Eating only so many “points” worth of food each
day does the same thing. And so on. Where some of these diets fail, in my
opinion, is by failing to hammer home some basic nutritional concepts that help
people keep the weight off in the long run. When they add carbs back in, the
weight comes back. Or they might start increasing their intake of low-carb
foods to the point that they are once again eating a caloric surplus. Once the
meal replacements are replaced with real foods, people haven’t learned about
portion size, so they just go back to doing what they were doing that made them
gain weight in the first place.<o:p></o:p></div>
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<br /></div>
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So paying attention to the amount of calories you eat is
important – that should be clear. Problem is, most people are terrible at
estimating how many calories they are eating. They might think they are eating
less and are confused as to why they are not losing weight or even still
gaining it, but they don’t realize that they are still eating at a surplus, or
perhaps have just reduced their intake down to maintenance levels. <o:p></o:p></div>
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<br /></div>
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So how best to keep track? I started using a free app on my
phone called <a href="http://www.myfitnesspal.com/" rel="nofollow" target="_blank">MyFitnessPal</a>.
It’s an awesome, easy-to-use way to keep track of things. They have a huge food
data base and you can typically just type in whatever you are eating and find
it. They have pretty much every major restaurant’s food and a lot of smaller
restaurants as well, which makes it convenient when you are eating out. You can
also build common meals and save them to use them again later. It remembers
what you typically eat, which makes it easier to use the longer you use it. It
also can keep track of your weight and other markers as well. For someone like
me who likes data points and keeping track of things, it’s awesome. Additionally,
it only takes maybe 3-5 minutes a day – tops – to use once you have things
down. So it takes minimal time, but it allows you fairly fine control over your
caloric intake – which is THE MOST IMPORTANT STEP when it comes to losing fat
or gaining muscle. <o:p></o:p></div>
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<br /></div>
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Of course, as with any data, if your data is trash then your
conclusions are useless. Be honest about what you enter. When in doubt,
I try to overestimate what I’m eating (because most people usually underestimate).
<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
That said, I’m not a huge fan of weighing or measuring
everything you eat. My guess is most people aren’t. It’s just inconvenient. For
some who are trying to get into peak condition, it might be necessary. For most
of us, though, it’s probably not. You might find it helpful to weigh something
once or measure something once just to get an idea of what a cup of this or 12
oz. of that actually looks like, but don’t get too crazy. <o:p></o:p></div>
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<br /></div>
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Once you’ve downloaded the app (you can just use it on the
computer as well, but the app is way more convenient), track your intake for a
few days. Be honest. You have to figure out where you are to figure out why you
got there and where you are going to go.<o:p></o:p></div>
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<br /></div>
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<b>Finding Your Numbers</b><o:p></o:p></div>
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<br /></div>
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So you have the tools to keep track of your calories, which,
if you haven’t caught on by now, is IMPORTANT. Now what? <o:p></o:p></div>
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<br /></div>
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The next step is to figure out what your goal is. For most
people, this will be something like, “Well, I want to lose fat and gain muscle.”
That’s great, but with the exception of rank beginners, it’s unlikely to occur.
It’s possible, of course, but progress will be exceedingly slow and you are
really working at counter-purposes with yourself. Remember, to lose fat you
have to eat less, and to gain muscle you have to eat more. You can’t really do
that at the same time – you cannot serve two masters. So pick your goal, and go
with it. <o:p></o:p></div>
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<br /></div>
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But getting back to the topic of this section. You need to
establish your caloric maintenance requirements – the amount you need to eat to
stay the way you are. The calculator I like (which has lots of features, which
we’ll talk about later) can be found <a href="http://www.1percentedge.com/ifcalc/" rel="nofollow" target="_blank">here</a>.
Plug in your numbers, be honest about your activity level, and select which
formula you want to use to calculate your caloric needs (I would just choose
the one with the most conservative values for starters – it’s easier to add in
calories later if needed than it is to remove them). That’s your maintenance
caloric requirement. <o:p></o:p></div>
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If your goal is to lose fat, you need to eat less than that
number to achieve that. The typical recommendation is to eat 500 calories under
your maintenance each day – over a week, these leaves you with a caloric deficient
of about 3500 calories. Traditionally, this is the amount that is touted as necessary
to lose a pound of fat a week. You can also set your deficit by using a percentage of your maintenance - so, for example, you might decide to eat 20% less calories than your maintenance level each day. If you want more information on choosing the correct deficit, I would recommend reading <a href="http://evidencemag.com/fat-loss-deficit/" target="_blank">this</a> article. <a href="http://www.bodyrecomposition.com/fat-loss/setting-the-deficit-small-moderate-or-large.html" target="_blank">This</a> one is also a good read on the topic. <o:p></o:p></div>
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<div class="MsoNormal">
That’s one way to do it. Problem is, over time, as you eat a
deficit your metabolism does slow a bit. Additionally, traditional dieting like
this tends to lower the levels of a number of important hormones in your body
(you can read more about this effect <a href="http://www.bodyrecomposition.com/muscle-gain/calorie-partitioning-part-2.html" rel="nofollow" target="_blank">here</a>).
All bad things. <o:p></o:p></div>
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<div class="MsoNormal">
<b>Enter the Cycle</b><o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
One way around this is calorie cycling – eating less one day
and more on another such that you still eat at the deficit you need to lose
fat, but while sort of “tricking” your body into thinking that you’re not
actually starving it – this helps keep it from hanging on to stubborn fat and
generally making you feel like crap. <o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
So how do you do this? There are a couple of ways. First,
start looking at your calorie requirements over a week rather than just over a
day. So, for example, say Person A needs 2500 calories a day. Over a week, that’s
2500 calories x 7 days = 17,500 calories/week. If you wanted to eat at a deficit
of 3,500 calories, then that means you need 17,500 calories – 3,500 calories =
14,000 calories over the course of the week. You can then choose to divvy up
those calories across the days as you see fit – you might want to eat more on
days you work out and less on rest days, or save some calories for that meal
out with some friends. You can wave your calories throughout the week to avoid
the pitfalls of straight dieting however you choose. That said, I personally
just like to use the old rule of thumb that says eat 10 times your bodyweight in
calories on rest days and 12 times your bodyweight in calories on work out days
to lose fat. I’ve had the most success with this method, and have so far lost
about 20 pounds. You can work out the numbers, but when training 3x a week,
this puts me at the perfect deficit. <o:p></o:p></div>
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<br /></div>
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Alternatively, you can go back to the calculator I gave you
earlier and select one of the fat loss options. It will run the numbers for you
and show you how much you can expect to lose per week (these are only
estimates, of course) and how much you should eat per day on both work out and
rest days. <o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
An important note: as you lose weight, you will need to
account for this. Recalculate your caloric requirements every 5-10 lb.
Otherwise, your deficit will over time become your maintenance.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>One More Important Tool</b><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
One final thing I will say here is that, for weight loss in
particular, one tool that I’ve found particularly helpful is something called
Intermittent Fasting (IF). This isn’t a diet – it’s more of a pattern of
eating. The basic idea is that you set up an “eating window” – typically something
like 4-9 hours – and then fast until your next eating window. It may have some
health benefits in terms of reducing risks for various diseases and improving
lipid profiles and speeding up fat loss, but more than anything it’s just darn
convenient. A typical way to go about it is to eat from, for example, noon to 8
pm and then fast for 16 hours until noon the next day. It takes a little
getting used to at first, but after a while some people report increased mental
clarity and focus, as well as a feeling of well-being, during the morning part
of the fast. I’ve found that to be true, as well. <o:p></o:p></div>
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<div class="MsoNormal">
But what about breakfast? Isn’t that the most important meal
of the day? And don’t I need to eat every 2-3 hours to keep my metabolism speeding
along? My body will consume itself!!!<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
Slow down. All are valid concerns, but have been addressed
elsewhere. I recommend reading <a href="http://www.nerdfitness.com/blog/2013/08/06/a-beginners-guide-to-intermittent-fasting/" rel="nofollow" target="_blank">this</a> for a great overview of IF and answers to many common questions. <a href="http://www.muscleforlife.com/the-definitive-guide-to-intermittent-fasting/" rel="nofollow" target="_blank">This </a>is a good
overview too.
Another great read can be found <a href="http://www.leangains.com/2010/10/top-ten-fasting-myths-debunked.html" rel="nofollow" target="_blank">here</a> - it discusses some of the common myths surrounding fasting. Also <a href="http://www.wannabebig.com/diet-and-nutrition/why-you-should-be-skipping-breakfast-the-secrets-of-intermittent-fasting/" rel="nofollow" target="_blank">here</a>. <a href="http://www.precisionnutrition.com/intermittent-fasting" rel="nofollow" target="_blank">This </a>is a great overview and analysis of different ways to go about fasting. If you're going to do IF, I'd recommend taking a few minutes to read through those links. (Update 2/18/15: A comprehensive guide about how to "do" intermittent fasting can also be found <a href="http://www.straightforwardfatloss.com/leangains-guide-fasting-fat-loss/" target="_blank">here</a>. In the interest of full disclosure, I'll note that the owner of the site contacted me about listing his link here, but it seems like a solid website that's definitely worth looking over if you are interested.)</div>
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One of the things I like about IF, especially while eating
at a deficit, is simply that it allows me to “save” a lot of calories for later
so that, when I do eat, I get to eat a couple of larger meals instead of eating
like a bird throughout the day. Also, it’s a lot easier to get out of the door
in the morning not having to worry about making and eating breakfast. <o:p></o:p></div>
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<br /></div>
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A brief note about weight lifting while using IF – there are
several ways to go about this, most of which are addressed in the links above
(which you should read if you are going to do this). I personally tend to
usually only fast on rest days, since I tend to lift weights in the mornings (which
means a whey protein shake beforehand and then a meal after working out) and am
not a fan of stopping eating at 3 pm in the afternoon to keep my “eating window”
intact. And it’s ok. Do what you can. If you work out in the evenings anyway,
then this won’t be an issue. <o:p></o:p></div>
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<br /></div>
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<b>Keeping Track</b><o:p></o:p></div>
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<br /></div>
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So you have the tools for fat loss. I’ll talk a bit about
weight training here in a bit, but first let’s talk about tracking your
progress. <o:p></o:p></div>
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<br /></div>
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The first thing I’ll say is that changing your body
composition takes time. Weeks, months, even years. So don’t be discouraged if
you don’t see changes right away. When you make a change, give it at least
three weeks or so – preferably more – to see if something happens. <o:p></o:p></div>
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<br /></div>
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But how do you know if something is happening? By seeing if
your metrics are changing. Personally, I use the scale, calipers, and the
mirror. The scale is great for keeping track of weight changes, but doesn’t
tell you if you are losing or gaining fat or muscle. That’s where calipers come
in. Get a cheap pair of reliable calipers (I use the <a href="http://www.amazon.com/gp/product/B000G7YW74/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=B000G7YW74&linkCode=as2&tag=dysgramusing-20&linkId=77PGCASAEU4WZJWG" target="_blank">Accu-Measure Fitness 3000 Calipers</a> - they are about six
bucks and well-regarded), and learn how to use them (<a href="http://www.linear-software.com/online.html" rel="nofollow" target="_blank">this website</a> is great for
both learning how to use them and calculating your body fat percentage).
Note that the body fat percentage might not be spot on accurate, but it’s more
important that you are consistent so that you can track changes. I’d recommend
weighing and taking caliper measurements once a week under the same conditions –
I do this Saturday mornings, after getting up and using the restroom and before
eating or drinking anything. Once again, be patient. It takes time for your
body to change.<br />
<o:p></o:p></div>
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<br /></div>
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Note for females: you might find that you retain water
differently throughout your monthly cycle, so your weight may vary from week to
week. Thus, it might be more helpful to compare weights/body fat measurements
from week 1 of cycle 1 to week 1 of cycle 2, week 2 of cycle 1 to week 2 of
cycle 2, and so on.<o:p></o:p></div>
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<o:p> </o:p> </div>
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<b>One More Word about Diet</b><o:p></o:p></div>
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYDlDLvoUVOIZNFBS5D41kPPlf3yS-M2Fe4iScahFZ1APyA-9cKQw4GUJZ67NVh21twBB1fPQJavnnZMGMUkpO-KijJvSdltQ6TbPOsCTVgQknVMbHn1yAwd6rKaixeCEOqMlJ7Mvkr74/s1600/fasting.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYDlDLvoUVOIZNFBS5D41kPPlf3yS-M2Fe4iScahFZ1APyA-9cKQw4GUJZ67NVh21twBB1fPQJavnnZMGMUkpO-KijJvSdltQ6TbPOsCTVgQknVMbHn1yAwd6rKaixeCEOqMlJ7Mvkr74/s320/fasting.jpg" width="208" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Image courtesy of <a href="https://homefitnesslife.com/blog/workouts-and-tips/intermittent-fasting/" target="_blank">Home Fitness Life</a></td></tr>
</tbody></table>
So you know how important calories are, how to keep track of
them, a bit about intermittent fasting, and how to keep track of changes in
your body composition. I haven’t discussed much yet though about what to
actually eat. I won’t say much about this except that I really just make sure
my protein intake is on par (at least 1.5 g/kg body weight) and let the rest
(carbs, fat, etc.) fall where they may while generally eating quality foods. Also,
drink plenty of water – you want at least five clear/light yellow pees a day. That’s
the easiest way of doing it, in my opinion. You can get a little more crazy
with this if you want to – see <a href="http://iifym.com/" rel="nofollow" target="_blank">this website</a> for more information.<o:p></o:p></div>
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I will say that I typically still eat ice cream, albeit in
smaller portions, fairly regularly. Remember, at the end of the day, your goal
is to meet your calorie requirements for whatever you are trying to do. If you can
squeeze in a cup or two of ice cream into your calorie log, so much the better.
Like I said before, you don’t want to eat crap all of time, but life is too
short to go too crazy with this stuff and you can change your body composition
successfully while still enjoying yourself. <o:p></o:p></div>
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<b>To Gain or to Lose?</b><o:p></o:p></div>
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If you aren’t sure where to go from here, figure out where
you are at first. For guys, a healthy body fat percentage is about 10-15%. For
gals, that can be more like 18-25%. If you are a guy who wants to gain muscle,
but are at 19%, then you need to lose some weight first. This is for a variety
of reasons, but for now I’ll just say that first, fat is not functional tissue.
It does not make you stronger; it just slows you down. Second, the fatter you
are, the more likely your body is to just gain more fat. The leaner you are,
the more like your body is to gain muscle (see <a href="http://www.bodyrecomposition.com/muscle-gain/calorie-partitioning-part-1.html" rel="nofollow" target="_blank">here</a> for more).
Conversely, the fatter you are, the easier it will be to lose fat. The leaner
you are, the harder it is to lose fat (unfortunately). So, getting down to a
leaner you will, on a lot of levels, be better for your overall progress. I
would recommend getting down to at least 10% or so before starting to gain
weight again. Hold your diet there at maintenance levels for about two weeks to
allow your body to “settle.” When you decide to gain, try to only gain about
one pound per week (will be some fat and some muscle) until you get up to
around 15% body fat or so. Again, hold there for two weeks before starting to
cut weight again. Repeat until satisfied. <o:p></o:p></div>
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<br /></div>
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As far as eating for weight gain goes, just eat more. I would
recommend calorie cycling still – use the <a href="http://www.1percentedge.com/ifcalc/" rel="nofollow" target="_blank">calculator</a> above to figure out what you need to eat on rest and work out days for weight gain. Keep
track of your progress weekly, and don’t let things get out of hand. <o:p></o:p></div>
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<b>A Brief Word on Weight Training</b><o:p></o:p></div>
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Weight training is an important component of any exercise program.
Or, at the very least, it’s a very valuable addition. Obviously, be realistic and
consult with your physician if you have any question about whether weights, or
any exercise for that matter, is right for you. <o:p></o:p></div>
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I also want to make a note that weight training is for both
men and women. Women sometimes fear that it will make them bulky, but short of
using exogenous hormones, they just don’t have the hormone profile for this to
be even remotely true. Guys, similarly, sometimes don’t want to get too big. Don’t
worry – you won’t just wake up huge. These things take time. That said getting
stronger has multiple benefits for life in general and can be just darn
helpful. <o:p></o:p></div>
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I’m a big believer in safely performing basic compound
exercises – squats, deadlifts, bench press, overhead press, rows, dips, and
chins. Do those, increase your weight over time, and you will get stronger. If
you are just starting out, I would recommend something like Starting Strength
(can be found <a href="http://startingstrength.wikia.com/wiki/The_Starting_Strength_Novice/Beginner_Programs" rel="nofollow" target="_blank">here</a>; I like the Practical Programming version)
or Stronglifts (can be found <a href="http://stronglifts.com/" rel="nofollow" target="_blank">here</a>).
After you’ve progressed as far as you can on those, check out Jim Wendler’s 5/3/1
(the basic program can be found in various places online, but you should buy and read the book <u><a href="http://www.amazon.com/gp/product/1467580309/ref=as_li_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=1467580309&linkCode=as2&tag=dysgramusing-20&linkId=OAEAMJCGZOF4CT2F" target="_blank">Beyond 5/3/1: Simple Training for Extraordinary Results</a><img alt="" border="0" src="http://ir-na.amazon-adsystem.com/e/ir?t=dysgramusing-20&l=as2&o=1&a=1467580309" height="1" style="border: none !important; margin: 0px !important;" width="1" /></u> and pick your variation) or some of Paul
Carter’s programs. I wish I had progressed like that when I first started.<br />
<br />
(Edit: Since I wrote this, some excellent resources have been put out by Greg Nuckols - a very strong and very smart guy. Head on over to his website (a good place to start is <a href="http://www.strengtheory.com/complete-strength-training-guide/" target="_blank">here</a>) and enter your email [don't worry - this guy is legit. The worst he'll do is send you some awesome information that you can unsubscribe from at any time] to get his free training programs. He'll send you an excel file with a bunch of programs that can be used at essentially any level and that you can progress through as you get stronger. That is probably one of the best ways that anyone could get started on their strength-training journey.)<br />
<o:p></o:p></div>
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Note that I said that I’m a believer in SAFELY performing
these exercises. Spend some time learning and refining your technique before
adding much weight. These exercises are not inherently dangerous or bad for you
– unless you are doing them wrong. Check out <a href="http://www.exrx.net/" rel="nofollow" target="_blank">ExRx </a>for pointers. Also, I
really like these articles for technique:<o:p></o:p></div>
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Squat: read <a href="http://www.lift-run-bang.com/2010/04/developing-your-raw-squat-pt-i.html" rel="nofollow" target="_blank">this</a>.<o:p></o:p></div>
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Deadlift: read <a href="http://www.bodyrecomposition.com/training/clean-style-deadlift-technique.html" rel="nofollow" target="_blank">this</a> and <a href="http://www.lift-run-bang.com/2014/02/some-technical-errors-that-maybe.html" rel="nofollow" target="_blank">this</a>.<o:p></o:p></div>
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Bench Press: READ THIS – <a href="http://www.lift-run-bang.com/2011/11/developing-your-raw-bench-part-1.html" rel="nofollow" target="_blank">Part 1</a>,
<a href="http://www.lift-run-bang.com/2011/12/developing-your-raw-bench-part-2.html" rel="nofollow" target="_blank">Part 2</a>,
<a href="http://www.bodyrecomposition.com/training/bench-press-technique.html" rel="nofollow" target="_blank">this</a>,
and <a href="http://www.bodyrecomposition.com/training/benching-with-the-pecs.html" rel="nofollow" target="_blank">this</a>.<o:p></o:p></div>
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Check out <a href="http://www.exrx.net/" rel="nofollow" target="_blank">ExRx </a>for form instructions for the other
exercises. <o:p></o:p></div>
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<b>A Brief Word on Cardio</b><o:p></o:p></div>
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“Cardio” is what people typically first think of when they
think of trying to lose weight. By now you should know that that is not
necessarily the case – calories are most important. That said, you can use
cardio to help create your deficit, and it’s also useful for increasing your
overall work capacity. It’s useless to be strong but unable to walk down the
block without doubling over or finish a fight. I try to lift three times a
week, and fit in at least two cardio sessions. What you do isn’t really that
important. Swim, ride a bike, do bag work, sprint, go for a walk. Just be
active and do something you enjoy. Set a goal and achieve it. I used to be a
lifeguard, and at least once a week we had to swim a 500 (20 laps in a 25 meter pool). I used to
be able to knock that out without a second thought – now I can barely get 10
continuous laps. So that’s my goal. I try and hit the pool twice a week, and am
working towards getting better every time. <o:p></o:p></div>
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<b>Conclusion</b><o:p></o:p></div>
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So that’s that. Medical school is busy, but it’s entirely
possible to set up a routine that has you lifting two to three times a week and
doing some form of cardio at least twice a week. Controlling your food intake
is made much easier by using the tools that I discussed above, and after a
while won’t take much thought at all. Getting started is the hardest part, but
once you’ve overcome that initial inertia, it will begin to work in your favor.
Good luck.</div>
eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com0tag:blogger.com,1999:blog-2365930991142326796.post-85659405195075268882014-07-15T13:51:00.000-05:002014-07-16T15:28:40.716-05:00Anki Q&A: Part 2<div>
Since my last <a href="http://www.dysgraphicmusings.com/2014/03/anki-q.html" target="_blank">Anki Q&A post</a>, I’ve received several more questions on how I’ve been using Anki and how to integrate the program into the workflow of medical school. For those of you who are interested, I’ve put together some of the questions (slightly edited for brevity’s sake) and my replies below.<br />
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<b>Q: So prior to class, you upload the PowerPoint slides into OneNote, annotate them during the lecture, and review things afterwards, correct? Are you taking extensive notes during class or just focusing on the big picture and highlighting things the instructors stress? Do you also create review notes in OneNote as well? Or do you use Anki exclusively as your studying and reviewing tool? How do you know what to put into Anki? Do you use First Aid?</b><br />
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<b>A:</b> Some of the details of how I studied for each class varied, but the general process was something like upload PPT slides to OneNote the night before, go to class in the morning, take notes (I usually took pretty extensive notes in class, but since I’m typing notes this really isn't too bad. In undergrad, I took handwritten notes, but that wouldn't work for me now. Some people do it, though…), and go home/wherever I'm going to study. By this point, I've usually finished or at least started reviewing my old cards. If I haven't, then I do that now. Once that's done, I'll start making new cards – this is where I would go back over my notes for the lecture (not necessarily watching it again, but you could) and try to integrate things. I know of at least one person who makes Anki cards while sitting in class. I personally couldn't do that, just because I feel like sometimes the professor will say something or show a slide that makes something he or she said 20 slides ago make much more sense.<br />
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Anyway, this is the time where I really integrate the details. I usually walk out of lecture with a decent idea of the big picture, but how all of the details come together is often still a bit fuzzy. While I'm going over the details of my notes and making sure I understand things, I’m also bringing in other resources as needed (e.g. BRS for physio or your text of choice).<br />
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How I make cards has changed a bit over the past year. I used to make a lot of basic, front/back flashcards. Which are fine, depending on the subject. I started using a lot of image occlusion for anatomy, which is where Anki really shines. For more process-oriented subjects like physiology, I started using more cloze deletions at first, and then started basically creating mega cards in OneNote (e.g. compiling all of the information I need to know or found interesting about, say, sodium handling in the nephron - usually in the form of words and a few pictures - on one screen-sized page, screen-capturing it (using OneNote's super-helpful screen capture tool), and then using image occlusion over that.<br />
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Now, technically speaking, that's a really bad card. Personally, though, I found it helpful in terms of keeping enough details in one place such that it was reviewable three months later when the details might start getting a little fuzzy. I have an image-occluded answer that I have to answer, but then I also have context surrounding it that brings that answer to life if I forget why it's right. Again, your mileage may vary. That's something I found helpful, but different things are obviously going to be more helpful for different people, as you mentioned.<br />
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As far as what I try to include, I just put in there anything the professor stresses, anything that's in First Aid or a USMLE-oriented review source like BRS Physio, anything I need to understand the concept, or just anything that I find interesting. Again, one advantage of the mega card is that I can have more information on one screen than I actually need to memorize (that is, I don't need to cover over a word in every sentence or over every item in every figure - just over some of the key points. Then, if I need to remind myself of why those key points are important later on, I can just read the context for a quick review).<br />
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I hope that made sense. I know the mega card concept might be a bit confusing, so I've included some pictures below. Basically, for a card about renal sodium handling, I might write up a few short paragraphs about the process, throw in a couple of pictures that proved helpful, and screen-capture the whole thing, using the image occlusion tool to then block out of a few key words or image labels (basically using it as a cloze tool for the paragraphs).<br />
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The first year is over now, and looking back I'm super glad I used Anki. It made it much easier to review for tests (since I'd already seen the info several times using Anki, I usually would just do a quick review of my notes in the couple of days before a test), and score-wise on tests things went great. So it seemed to work. Now the test will be to see how it helps me retain things long term, and it will be interesting to see what, if any, tweaks to the process I make next year.<br />
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<b>Q: I have a question for you about when you said you "looked back at your notes". I ask because some people first do a megareview sheet that compiles class notes, FA material and review books (ie BRS Physio, Lippincott's Biochem etc) before transferring some/most of that info into Anki cards. Did you use Anki as your primary review source like that youtube video in your blog of that student who annotated his notes in OneNote and then made Anki cards as he went along or did you have a separate review sheet? </b><br />
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<b>A:</b> I didn't really make a separate review sheet per se. What I did do was sit down with my OneNote notes and review books after lecture and, within the OneNote program, create a “megacard” that covered part of the lecture. I might make 3-8 megacards per lecture, depending on what we covered. I would then screen-capture the megacard and use image occlusion to make cards out of it (note: in the videos I posted, you might remember there were two ways to use image occlusion - in one way, depending on the button you pressed to create the cards, if you had occluded, say, 15 words in a megacard, all of them are whited out except for the one you are reviewing. If you use the other way, then you can see all of the other answers while reviewing the one card you are actually on. It's not super important right now, except to say as a side note that I've found it more helpful to use the latter option - it's not very helpful three months down the road when you are reading over the entirety of a megacard to grease the wheels a bit and half of it is whited out. Sure, it might make the first review a little easier, since all of the answers are right there, but some would argue that you really don't need that review anyway....).<br />
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Within OneNote, I would just make a note to myself within that lecture of which pages the megacards were on, just so that when I came back around right before the test I wouldn’t have to flip through all 40 pages within a lecture - just the few that I had created the megacards on. Other than that, I never really used them. They're there, though, I suppose, in case I ever needed to reference them. But again, my primary purpose in making them was to create something I could make a card out of rather than make a review sheet. I never really was big into making review sheets, personally, except for things like some of the metabolic pathways. So all that to say that, yes, I did review my notes at least once before tests, but really Anki was my primary study source.<br />
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Note: To help explain the “megacard” concept, I’ve included some pictures below.<br />
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<b>Q: How do you know what is important and what is not? That is like the million dollar question but I believe you had said that after your exams you turn off some of the review cards because it was stuff that your Prof has said that were exclusive to the class/exam. Is it just by asking upperclassmen? </b><br />
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<b>A:</b> That is indeed the million dollar question. I personally chose to border on the side of making too many cards. Of course, that meant that there were seasons where I was reviewing 500 or so old cards per day (usually took about 1-2 hours, depending on the material). That's a good way to burn out, but again, it's also my primary method of studying, so there's that. I've said before that 20-50 cards per lecture is a good target, and that's true, but there are just some lectures that require 150 cards. Of course, part of that is just me learning how to make good cards and separating the wheat from the chaff, and part of that is the fact that some lecturers try to cram a huge amount of information into an hour long lecture.<br />
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In the beginning, you really won't know exactly what's important. You'll learn quickly, though, based on how your teachers test and what they emphasize. As a baseline, I'd recommend getting the bulk of what's in First Aid for whatever topic you're studying. You can also include information from a relevant review book that's directed at Step 1 prep, since FA can be sparse at times with respect to M1 material (which is also somewhat of a hint about what's important...that said, it is important to have a good foundation, especially when it comes to a course like physiology).<br />
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So I guess in order of importance I would definitely try to get information from FA (if any), then get most of the stuff on the topic from a review book (if you can get access to a digital copy, that works great for incorporating them into megacards), then include any major stuff that your professors emphasize that's not in those resources. That's a decent baseline. After that, you can debate with yourself about including stuff that is extraneous or perhaps that you just find interesting. As a side note, again, the cool thing about megacards is that you can include all of that stuff (the baseline stuff + the interesting stuff/extra explanations/etc. that really don't merit their own card) on one megacard, but just make actual cards out of the important stuff. The extra stuff, then, is just there to review at your leisure.<br />
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<b>Q: I kind of get what you meant about the OneNote megacards – could you possibly print screen a few of your cards to clarify? Also, I am new to OneNote but am impressed by the interface and like it much better than EverNote. However, my problem is this: let’s say that your class notes are in one tab and your personal notes are in another tab or section, can one open your class notes in a new window and have them next to your personal review sheet in terms of referencing and creating these Megacards? I hope that makes sense. Also, are you using Office 365? I ask because I am wondering how one can backup their OneNote data and/or be able to access it from a remote computer if needed. By the way, do you have Windows 8? If so, how do you like it compared to Windows 7?</b><br />
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<b>A: </b>Pictures definitely help. I attached a couple of pictures from my review today as an example. In the "Card Front" picture, I just took a screen shot of Anki - you can see that there is a megacard on hormonal changes during pregnancy, in this example. For this card, I used image occlusion to block out a word on the top right - that's the red box. When I answer the question, the box disappears and the correct answer is revealed. I probably have 10-15 cards or so within this one megacard, so not only do I see all of the information repeatedly (though I don't necessarily take the time to read through everything that's not related to the question at hand), but the individual "cards" are located within the context of the overall subject. In this case, for example, if I forget what some of the other hormones are doing, I can just read the megacard to find out. </div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikVNOaTnEBIZKHEOz-El1y4yGl-7JI0Cal4LwZbkQTMaP8yrJ1rqoC_pt_wYyvCGsGOpiWuXCeiGCpledFMhu1anEATOXEhRiFIX0av1gPyrixhptXEt9WtKi3Lo3w7TWnlQVuzQpLSZE/s1600/Card+Front.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikVNOaTnEBIZKHEOz-El1y4yGl-7JI0Cal4LwZbkQTMaP8yrJ1rqoC_pt_wYyvCGsGOpiWuXCeiGCpledFMhu1anEATOXEhRiFIX0av1gPyrixhptXEt9WtKi3Lo3w7TWnlQVuzQpLSZE/s1600/Card+Front.jpg" height="225" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Card Front</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpERba2G8BOrfIj3JbZi4vGw44gufaKg1Y61A0lBsaJqHwkfUGdFqrVJidATuQjtPyzXZpwGS68CVl6HnMFsXQ6Esk_tjNzspQRyrRpNgnPwPGBOHcCgSTFGYL7lALN9MiJcJc9kDObF4/s1600/Card+Back.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpERba2G8BOrfIj3JbZi4vGw44gufaKg1Y61A0lBsaJqHwkfUGdFqrVJidATuQjtPyzXZpwGS68CVl6HnMFsXQ6Esk_tjNzspQRyrRpNgnPwPGBOHcCgSTFGYL7lALN9MiJcJc9kDObF4/s1600/Card+Back.png" height="226" width="320" /></a></td></tr>
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On a side note, for this card I basically just screen-captured some text from BRS Physio. It's a review book, so it doesn't necessarily have all of the detail necessary for class, but I found it helpful for capturing the big picture. So in this case, I might make a similar card using class notes with more detail, but also make this one as a general overview, making sure that the cards complement each other rather than just making a bunch of duplicates.<br />
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For OneNote: I make a new notebook for each class. Within each notebook, I make a new tab for each lecture. Within each lecture, on the sidebar, I'll have a spot for the handout and the lecture PPT. You can see this in the attached picture "OneNote Image 1." </div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCKAfuU8wlBbOZGrYqnQjwz-fc4ficD2R7Ab8YWoZUtDGAkr53k3FJNkkPkflO4ufOVVg2JO5DXQ0qqvAeWqkVb9Q5Kx_WAhZH80P2elMBV9f8PgFFCC-nEyxLTxOfzCSb99pMk6HABx8/s1600/OneNote+Image+1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCKAfuU8wlBbOZGrYqnQjwz-fc4ficD2R7Ab8YWoZUtDGAkr53k3FJNkkPkflO4ufOVVg2JO5DXQ0qqvAeWqkVb9Q5Kx_WAhZH80P2elMBV9f8PgFFCC-nEyxLTxOfzCSb99pMk6HABx8/s1600/OneNote+Image+1.jpg" height="159" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">OneNote Image 1</td></tr>
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During lecture, I'll follow along with the PPT and take notes next to the individual PowerPoint slides. You can see an example of this in "OneNote Image 2."</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTSnjNN9yWehzI-MKohjZ-aH0Mt-TLxQydZOSN53Qen2Pl2SWpSfqsaONLtDgPuR15GaaDjYhDBDp71n7csAghXJJyr0j4vwV7mrZRAx-q0Jr5nR4AGzbzWnu8h5BUiSO44vhN3ay3EYs/s1600/OneNote+Image+2.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTSnjNN9yWehzI-MKohjZ-aH0Mt-TLxQydZOSN53Qen2Pl2SWpSfqsaONLtDgPuR15GaaDjYhDBDp71n7csAghXJJyr0j4vwV7mrZRAx-q0Jr5nR4AGzbzWnu8h5BUiSO44vhN3ay3EYs/s1600/OneNote+Image+2.jpg" height="158" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">OneNote Image 2</td></tr>
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After lecture, I'll start reviewing the lecture and make Anki cards. Part of this is creating the megacards, if the lecture/class/topic calls for it. You can see in the first OneNote image how, under the handout of the Complement lecture, I've written "Review" in some of the page titles. Those are the pages where I've created megacards. If I were to click on that page, it would bring up the handout page, but if I scroll to the right, I would see what you can see in "OneNote Image 3" - a megacard. I would screen capture this to use it in Anki, and then come back to it later just before the test to review it. </div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4R0yizGxjJ5wMxwtOJRljdfkOol8SJUitiyta3CrAHw7AU7y-YuLQqCh9ZlBm7qNbslzfx50HugDPrKgBbaNam9_IN8eWcetc5ZXUEm4Qlj9YJGbXDXOpg5eIxO9B41yxIMT9Snn1MX8/s1600/OneNote+Image+3.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4R0yizGxjJ5wMxwtOJRljdfkOol8SJUitiyta3CrAHw7AU7y-YuLQqCh9ZlBm7qNbslzfx50HugDPrKgBbaNam9_IN8eWcetc5ZXUEm4Qlj9YJGbXDXOpg5eIxO9B41yxIMT9Snn1MX8/s1600/OneNote+Image+3.jpg" height="163" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">OneNote Image 3</td></tr>
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As far as backup goes, OneNote is tied in with OneDrive (formerly Skydrive), which is a cloud storage option with Microsoft. If you log into your OneDrive account online, you can theoretically remotely access your Notebooks. I honestly don't use this that much. But it's there. I also back up my notebooks to my computer in a separate file, and my entire computer is backed up using a program called Carbonite. So I'm not too worried about losing any data, but you never know.<br />
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I bought a computer before medical school, and it does run Windows 8. I really liked Windows 7, and wasn't too excited about switching, but I was surprised at how much I actually ended up liking it. It takes a little getting used to. I spent some time watching videos online about how to use it and navigate the system efficiently, since it's really not as intuitive as Microsoft likes to think it is. I probably wouldn't like it as much if my computer wasn't a touchscreen, although it really shouldn't make much of a difference.<br />
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<b>Q: I'll keep this short; I'm a busy student myself! <a href="http://www.gwern.net/Spaced%20repetition" target="_blank">Here's a link to a paper</a>. If you have time, there is some interesting information there. One part that stood out to me was the superiority of free-recall vs. Cloze deletions in strengthening of memory in one of the papers cited.</b><br />
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<b>A:</b> Great article – thanks for sending that along. I will just briefly say two things about this: first, in the paper in question (Glover, 1989), free recall techniques were in fact shown to be more effective than cloze deletions (“cued recall” in the paper). That said, cloze deletion was still shown to be a superior method of learning for the purpose of retaining information. Second, there are always “better” ways of doing things, but in life – and particularly in a busy environment like med school – sometimes being efficient means striking a balance between “best” and “good” ways of doing things in order to maximize the time you have available. In an ideal world, sure, free recall is probably best for most things, but I’ve found that, practically speaking, cloze deletions get the job done and allow me to do well on tests while retaining information and still spend time with my family at night. At the end of the day, that’s a win in my book. Other students might find other methods to be more suited to their preferences and goals. That said, this is a pretty awesome paper in that it really goes into detail about the “why” behind the theory of spaced learning.</div>
eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com4tag:blogger.com,1999:blog-2365930991142326796.post-21914850557954484942014-05-26T17:49:00.002-05:002014-05-26T17:49:57.705-05:00The End of the First Year<div>
<span style="font-family: inherit;">As May fades away in the rearview mirror and we delve deeper into the first hints of summer, it’s hard to believe that the end of the first year of medical school has arrived. Much has happened in the past months. It seems as though we have learned more information in one academic year than many of us learned in most of our undergraduate experiences. We’ve been transformed from relative newcomers in the world of medicine to perhaps the most basic level of initiate – familiar enough to poke our way around and recognize a thing or two here and there, but with so much remaining incredibly foreign to us. We’ve been taught the basic skills of patient interviews and exams, and have gone from bumbling around in our standardized patient sessions (what do you do with this otoscope? Or is it an ophthalmoscope...?) to being able to perform relatively fluid interviews and make our way through a rudimentary exam (although, really, we’re still bumbling around – perhaps just in a slightly more polished fashion). Finally, my wife gave birth to our son almost four weeks ago – a busy addition to an already busy life, but a more than welcome one. We’re happy to have him here.</span></div>
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<span style="font-family: inherit;">We’ve learned so much that sometimes it’s easy to think that we have come far in our medical education. And, to be sure, we have – but by no means as far as we might like to think. I was reminded of this once again while recently shadowing my third year student preceptor while he was rotating on pediatrics. While listening in on their table rounds, I was able to pick up on certain little things here and there (hey, beta-2 microglobulin? I know what that is!), but most of it flew far above my head. But while I don’t understand most of the finer points of what was being discussed, or at least only understand certain things on a rudimentary level, I found it incredible to watch how the providing team took all of these random minutia (most of which I hadn’t learned, some of which I had but was surprised to see show up in such a practical way) and fit the seemingly-unrelated pieces together to construct a coherent diagnosis and treatment plan. It was simultaneously daunting (we have to learn all this stuff?) and encouraging (it will be pretty cool to be able to do that…) to watch their finely-tuned performance.</span></div>
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<span style="font-family: inherit;">Though I’m frequently reminded of how far I have yet to go, sometimes we get the opportunity to flex our “clinical muscles,” so to speak, and practice what we’ve learned – which is always a satisfying experience. One of the ways I was able to do this was while shadowing my physician preceptor, an internal medicine/pediatrics physician, at her clinic. There, I was able to interview several patients, including one who came in concerned that she had been feeling down for a while. She put on a brave face for the first few minutes of our interview, but when we began delving deeper into what was going on her life, she broke down into tears. My first instinct was to reach out and comfort her in some way, but I had to stop myself – this wasn’t a loved one, but rather a patient, and it probably wouldn’t help her much to have some random medical student wrap her in a bear hug. Still, though, I tried as best as I could to talk through things with her and encourage her. After I finished the interview, I presented her case to my preceptor and she came in and arranged further follow up with the patient. It was encouraging to see the patient leave with at least some hope for the future and a definitive plan in place to take care of her.</span></div>
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<span style="font-family: inherit;">I also had the opportunity to volunteer at some of the different free clinics around the greater Chicago area. With a multitude of patients to be seen and oftentimes only one, maybe two, attending physicians present, it’s a place where bright-eyed medical students can actually, sort of, kind of be somewhat useful. Or at least we’d like to think so. In any case, it does give us the opportunity to take our interviewing and examination out of the safe walls of our clinical skills center and into the world of real medicine. One patient in particular that I remember came in complaining of pain and swelling to his right lower leg over the past two weeks. He had a vague history of surgery to the area around six years ago or so in a different country, though he wasn’t sure what the procedure was or what it had been for. He’d now quit work because it was too painful to stand, and thus didn’t have insurance. I had the opportunity to interview him and perform an exam, noting things like pitting edema, good pulses, calf tenderness, and a distended area in his popliteal fossa that was tender to the touch. From some prior experience working in an emergency department, I was concerned that one possible cause for his symptoms might be a deep venous thrombosis. After leaving the patient’s room, I presented the case to the sole attending that was there, and after examining the patient he was also concerned that that might be the case, and started the process to get the gentlemen the care that he needed. While the role I played was small, it was still satisfying to have reached a point where I at least could recognize that something wasn’t right and build a case, using different points of evidence from the history and exam, to support what I thought was going on.</span></div>
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<span style="font-family: inherit;">So it’s been a busy year. Even though we’ve been done for almost a week, it took me a few days to realize that it was all over and I really, actually, honestly didn’t have any more material to study. I remember thinking over Christmas that it was cool to be halfway done with our first year, but then I would remember that it was only an eighth of the way through the entire thing. It’s nice to be able to say we’re now a quarter of the way done, and half of the way through the bulk of the classroom stuff. This summer, I’ve got a clinical research project lined up that shouldn’t consume too much time, at least after a couple of semi-busy weeks, which will leave me free to hang out with my wife and our new son. We’re all looking forward to it.</span></div>
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<span style="font-family: inherit;">P.S. I’ve been receiving more questions about how I use Anki. I’ll probably be doing a Anki Q&A: Part 2 sometime in the near future (the first one can be found <a href="http://www.dysgraphicmusings.com/2014/03/anki-q.html" target="_blank">here</a>). That said, feel free to send me any questions you’d like to see addressed, either via email (bloggeradmin@dysgraphicmusings.com) or the comment section below. </span></div>
eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com0tag:blogger.com,1999:blog-2365930991142326796.post-54209466981553618582014-05-01T23:12:00.001-05:002014-05-01T23:12:23.441-05:00Our Little HumanIt’s been a while since I’ve written a post. We’ve been going at breakneck speed through all of the organ systems in our physiology class, and just when I was starting to get a handle on that pace, we started immunology as well. Also, as I’m writing this, my newborn son is sleeping quietly next to me in his hospital bassinet. So yeah. Life has been busy.<br />
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Since starting with the cardiovascular system, we’ve slogged through respiratory physiology, the renal system (<i>bleh</i>), gastrointestinal physiology, metabolism, nutrition, endocrine physiology, and now we are just about to start our reproduction block (<i>how’s that for timing...</i>).<br />
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<tr><td class="tr-caption" style="text-align: center;">Image politely stolen from <a href="https://kaiserpermanentehistory.org/2011/06/" target="_blank">here</a></td></tr>
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So far, school has continued to go pretty well. Physiology has been, for the most part, an enjoyable class. It’s not like there is a ton of practical medicine contained within those hallowed PowerPoint slides, but you’ve got to start somewhere and it’s definitely more applicable than something like the molecular biology and genetics course we started out with. Immunology has also been surprisingly interesting. It’s one of those classes where getting the big picture is essential, but once you’ve got that down things start falling into place and making a lot more sense. Also, we’ve got less than a month left in our first year of medical school, which is awesome.<br />
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But the most exciting development in the past few weeks has been the arrival of our son. He was actually a little late, going by estimated dates and whatnot, since he finally rolled into town at 41 weeks. We actually thought he might come at least a couple of weeks sooner – my long-suffering wife had started feeling nauseous, really tired, and having more frequent Braxton-Hicks. Anecdotally, those things sometimes point towards impending labor, which was exciting. Of course, the weekend that she started feeling these things was the weekend before an extremely front-loaded test week, so we were crossing our fingers (or at least I was) that we’d be able to make it past at least two of the three exams we had that week before our son decided to arrive.<br />
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Make it past the tests we did. We also made it through the rest of the week, and the next weekend, and the rest of next week, and… you get the idea. Be careful what you wish for and all that, I suppose.<br />
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Finally, last Friday, we had another routine appointment at the hospital. My wife was a little bit dilated, which was exciting. Afterwards, they wanted my wife to have a non-stress test, just to assess fetal health since she was a couple of days past 40 weeks. The test involves her belly being hooked up to devices that measure the fetal heart rate and indicate whether or not she is having a contraction. Just like when we stand up or something and our heart rate increases a bit to compensate for it, when a baby is turning circles in his mother’s womb his heart rate should also go up. The test is basically looking for that to happen a certain number of times within 20-30 minutes. It’s a pretty basic screening test, though – if it’s “reactive,” or if the heart rate increases like it’s supposed to, then everything’s usually fine. If it’s “non-reactive,” though, or the test says that it didn’t pick up the heart rate changes, it’s actually wrong a little over half of the time.<br />
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Our test on Friday, of course, was non-reactive. It didn’t help that the nurse we had, while nice, was obviously new and wasn’t really doing much to inspire any confidence. We knew things were probably fine (my wife could feel him moving around quite a bit), but as a follow-up test they do something called a biophysical profile – basically an ultrasound where they measure various criteria and assign the baby a score that describes fetal health – the higher the better. Our son got the highest score possible, which was reassuring. That said, it turned into an unexpected four-hour hospital visit.<br />
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The doctors at the hospital wanted us to come back in on Saturday for another non-stress test, just to make sure things were fine. That one was fairly quick and painless, which was good. We had a fairly relaxing day on Sunday (with lots of walks! Walking is one of those things that is supposed to speed things along, so we spent a lot of time walking in the last couple of weeks).<br />
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On Monday, we had another follow-up appointment at the hospital. Everything was still looking good, but my wife hadn’t really progressed much since Friday. Which was fine, except having a large child inside of her belly was quickly getting really old, really fast. She spent most of Monday doing everything she could to get things going (massage, acupuncture, walking, various positional changes, etc.). Finally, Tuesday morning, she felt like her water might have started leaking. She really honestly wasn’t sure and otherwise felt fine (and we found out later it was really a pretty small leak), so she and her mother (who had flown in a few days earlier) went to the hospital to get checked on, honestly expecting to be sent back home. Since we thought that she would likely end up coming back home, and I had an exam that day at school, I went in that morning but kept my phone close. Before I got a chance to take the exam, though, they called and said it was in fact her water that had started to break. Finally!<br />
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I grabbed my stuff and headed out the door. For whatever reason, today of all days was one of the darkest, stormiest days we had had for a while. To get to the hospital, I was driving into the heart of the gloomiest-looking thunderstorm I had ever seen. Which was fine, except that when I got there it was raining cats and dogs and by the time I made it from my car to my wife’s car in the parking lot (to grab some bags) to the hospital, I looked like I had decided to take a noon-time swim in my dress shirt and slacks (we had dressed up for standardized patient interviews that day).<br />
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Originally, we wanted to stay at home as long as we could before going into the hospital, but since she had tested positive for Group B Strep (a type of bacteria that different people normally colonize at different rates – about 1 in 4 women or so are positive, but it can be very harmful to a baby that is exposed to it during the birthing process), she needed to come in a bit earlier to get antibiotics, which is really the only reason she called and came in when she did. Also, she really wasn’t having super strong contractions yet – they were still pretty basic Braxton-Hicks that she had been having all along. But again, since she was GBS positive, she really needed to start having contractions soon after her water broke. Since she wasn’t, they started her on a low dose of Pitocin (a synthetic form of oxytocin, the hormone that – among other things – causes uterine contractions during labor). She labored like a champ for eight or nine hours on the Pitocin drip (which is somewhat infamous for sometimes causing contractions that can be much more intense than those that you might have normally), and finally had an epidural late that night, which allowed all of us to relax a little bit and actually dose off for a few minutes at a time here and there. Finally, at almost 6 am the next morning, our son was born, weighing a healthy 7 lb 14 oz.<br />
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As I sit here now and watch him sleep (which is really something I should be doing as well, since sleep has been a rare commodity over the past day and a half and things don’t look to get any better any time soon), it’s almost surreal to realize that he is our child. It’s really incredible to realize that this temporarily peaceful little human belongs to you and is your responsibility. It’s something that is hard to grasp from just interacting with other people’s babies or young children – this little guy is yours, and it’s your job to keep him alive and teach him about life and all that that entails. It’s also incredible how darn cute and little he is, but I digress. Things will be busy, I’m sure, particularly with medical school in the mix, but I wouldn’t have it any other way.eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com0tag:blogger.com,1999:blog-2365930991142326796.post-18379293736781962014-03-13T15:30:00.000-05:002014-07-15T13:51:43.872-05:00Anki Q&A: Part 1<div>
Since I've started using Anki and writing about it on this blog, I’ve received a few questions about how I use it on a daily basis. Because I think Anki is awesome (though certainly not the only way to study for medical school – or study anything else, for that matter), and because if one person has a question, then usually there are several others with the same question, I’ve decided to write up a brief “Anki Q&A” based off of questions that I’ve received or I've seen commonly asked online. It’s important to note, however, that Anki is an extremely versatile tool, and though I use it in certain ways, the way I use it is far from the only way to do so. There is no “right” and “wrong” here – there are certainly more or less optimal ways to use the program, but ultimately it comes down to what works best for you – and what is best for you may not even be using Anki in the first place, depending on your study style. So take everything below as more of a starting point than as Anki gospel. If you have any other questions, please feel free to post them below in the comments section and I may add them to the post later on.</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglyz4eYYlG0NpPEBhJ3rVCy1BmfdV6sqoHeS-1KwN7U3AqIE7jDeXfZfmkfYdTfpbk4cfCRjq7JrD6GiZ2nCOwHHoedHml2C0kdbOwS8yhV_aWUdEjoqv4DZX3yLKhBYWpS7AJUT5PgFA/s1600/stack-of-flash-cards1.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglyz4eYYlG0NpPEBhJ3rVCy1BmfdV6sqoHeS-1KwN7U3AqIE7jDeXfZfmkfYdTfpbk4cfCRjq7JrD6GiZ2nCOwHHoedHml2C0kdbOwS8yhV_aWUdEjoqv4DZX3yLKhBYWpS7AJUT5PgFA/s1600/stack-of-flash-cards1.jpg" height="284" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Image politely stolen from <a href="http://ehovewire.blogspot.com/2010/12/8-great-flashcard-websites.html#.UyIS0fldUxE" target="_blank">here</a></td></tr>
</tbody></table>
<div>
<b>Q: Why Anki?</b></div>
<div>
</div>
<div>
<b>A:</b> I’ve written before about why I use Anki, and you can click <a href="http://www.dysgraphicmusings.com/2013/11/how-to-study-in-medical-school.html" target="_blank">here</a> to read a more in-depth explanation of the program and how to navigate its nuts and bolts. Briefly, though, I use Anki as a systematic way to retain the information that I’ve worked so hard to learn for the long haul. Before starting medical school, I commonly heard or read the writings of medical students bemoaning the fact that they feel as though they had forgotten large amounts of information as time passed. Obviously, to some extent, that’s inevitable. Also, much of the information we learn, particularly early on in medical school, isn’t crucial to remember to “be a good doctor.” Nevertheless, I did the binge-and-purge method of studying throughout undergrad, and frankly only remember half of it all, if that. I didn’t want that to be true for medical school.</div>
<div>
</div>
<div>
On a practical level, the process of making cards for Anki helps me to consolidate the information I am learning into discrete units of information that I can then tie together for a broader understanding of major concepts. Of course, simply staring at your notes after class or writing a summary page for each lecture or *insert method here* can do the same thing, so that’s not really unique. What is unique is that Anki then forces me to review that information precisely when I need to – I see it before I forget it but not until I need to, thereby helping me to avoid wasting my time by relearning information before a test that I had learned a few weeks ago in lecture and forgotten or by reviewing information that I already know.</div>
<div>
</div>
<div>
<b>Q: So you like flashcards. Why not something like Firecracker?</b></div>
<div>
</div>
<div>
<b>A:</b> I’ve personally not used the Firecracker program, but I’ve heard great things about it. However, I personally find the process of creating flashcards to be helpful in terms of making sure that I truly understand a concept before I just start mindlessly memorizing it. Also, Anki is pretty much free (the iPhone/iPad version costs about $25, but the desktop and Android versions are completely free). So that’s cool. That said, if you’re someone who doesn’t want to make flashcards (which is certainly a time commitment) but you want the advantages of spaced-repetition, I could see Firecracker being a great option.</div>
<div>
</div>
<div>
<b>Q: How many cards do you make per lecture?</b></div>
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</div>
<div>
<b>A:</b> Depends on the lecture. I usually try to shoot for somewhere around 20-50 cards per lecture, but honestly that depends largely on the type of cards I’m making (cloze vs. image occlusion vs. basic, etc.) and the content of the lecture. On average, as of late anyway, I’ve probably been making closer to 70-100 cards/lecture for physiology and immunology – mostly image occlusion cards. While that might seem like a lot, they really go pretty fast when I’m reviewing them later, mostly because I really try to have a card for each discrete fact that I want to remember, rather than, say, 10 facts on one card.</div>
<div>
</div>
<div>
<b>Q: How long does it take you to make your cards each day, and how much time do you spend reviewing old cards?</b></div>
<div>
</div>
<div>
<b>A:</b> On average, I’d say it takes about 1-1.5 hours to make cards for an hour-long lecture. Since I usually have about two lectures a day, I spend around 2-3 hours reviewing the lectures/clarifying concepts/making cards, and then maybe a half an hour reviewing them, depending on how many I made. Additionally, it takes anywhere from 30 minutes to an hour and a half or so to review old cards that are due that day, again depending on how many cards I made the previous day (and how focused I stay while reviewing them…). That said, the time spent reviewing old cards can be distributed throughout the day thanks to the Anki app that I have on my phone – that way, I can just knock out a few cards here and there throughout the day, so that by the time I’m ready to sit down and make new cards for the day, I’m done reviewing old cards or only have a few left.</div>
<div>
</div>
<div>
<b>Q: What type of cards do you make? What kind of stuff do you include?</b></div>
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</div>
<div>
<b>A:</b> Depends on the class/topic/how I'm feeling that day/etc. I started out making a lot of basic flashcards (e.g. "List the 4 steps of xzy," "What is abc?"). When anatomy hit, I found online textbooks to be very helpful because I could screen capture an image and use image occlusion to make cards out of it. For physiology, it's more conceptual so I've found myself using more cloze deletion cards. In fact (and this probably isn't the best way of doing things, but whatever), for long processes or complicated concepts where it's helpful to have a lot of information in one spot for future reviews, I'll make a really long card with all the relevant information I need and then the cloze the heck out of it, so that for some cards I have almost 20 individual clozes per card. You could also just put the relevant sentence or two on a card, and then put all of the excess stuff in the "extra" box so that it pops up for review when you answer the card, but putting it in the card makes it more likely for me to actually take the time to review stuff when I'm rushing to get through my cards.</div>
<div>
</div>
<div>
You can also write up a paragraph or two of information (e.g. how sodium is handled in the nephron), throw in a few pictures, arrange things so it all fits within your screen, screen capture it all, and then use image occlusion to block out words or phrases within a sentence (basically cloze deletions). Heck, if you’ve got good slides, you can just use image occlusion on those to make a decent, quick card.</div>
<div>
</div>
<div>
<b>Q: Do you keep reviewing all of the cards you’ve made throughout the year? Or do you stop reviewing certain decks/cards after you’ve had an exam on that material?</b></div>
<div>
</div>
<div>
<b>A:</b> So far I've kept reviewing all of my decks - I'm still reviewing some cards from our very first classes, and still reviewing things from anatomy last year. That, to me, is one of the major purposes of using Anki - a systematic way to review old material so that it's at least a little bit fresher when it comes time to take, for example, Step 1, or even if you just need to call upon the knowledge for whatever. That said, I do suspend certain cards that I wrote that contain details that really are irrelevant for anything but the test. However, I also only try to make cards for things that are worth remembering, so I really don't end up suspending a ton of cards.</div>
<div>
<br /></div>
<div>
That method isn't the only way to do it, obviously, but it is, for me at least, the method that is most consistent with what I want to get out of Anki - I view it not just as a way to do well on the next test (although it serves that purpose well), but as a way to review information that would otherwise slowly degrade over time, and using its spaced-repetition algorithm to eventually shift that information into my long-term memory. It's a commitment (I have around 12000 cards total now, and review anywhere from 200-400 old cards per day while making an additional 50-200 cards per day on most days - most of which is probably a bit excessive), but it's also my primary method of study, and no one ever said medical school would be easy. I personally would hate to have to tackle all of the information we learn without something like Anki to help me organize and process it. </div>
<div>
</div>
<div>
Anki might seem like a lot of work, and it can be, but it has been the best thing ever in medical school. It provides an organized way for me to integrate the information I'm learning, systematically review it, and retain that information for the long term. It can be a lot to keep up with on some days, but even though my weekdays are probably consistently busier than some of my classmates, my weekends are usually free, and I'm generally done by a reasonable time during the week anyway (usually, by the time I get home, review lectures for that day, make cards for those lectures, and review those cards, it’s around 5-7 pm). And it's paid off in terms of grades. Everybody learns differently, but this definitely has worked well for me.<br />
<br />
Note: Anki Q&A: Part 2 can be found <a href="http://www.dysgraphicmusings.com/2014/07/anki-q-part-2.html" target="_blank">here</a>.</div>
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eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com0tag:blogger.com,1999:blog-2365930991142326796.post-65855498949922899242014-02-21T22:29:00.000-06:002014-02-26T12:36:37.087-06:00A Terrible Day at the VA<div>
Oh. My. Gosh. What a day.</div>
<div>
<br /></div>
<div>
For our Patient-Centered Medicine course, we are paired with a physician and an M3 student mentor, both of whom we have to shadow a couple of times over this semester. Since my wife is due in April, I figured it’d be best to get those out of the way now. So, today, I shadowed my M3 mentor. He was on an inpatient psych rotation at the VA hospital near Loyola. Which is probably the most terrible place in the world (<i>ok, not really, but the events of today have left me rather ill-disposed towards it at the moment…</i>).</div>
<div>
<br /></div>
<div>
After navigating my way to the main entrance, where I was supposed to meet my mentor, I discovered that, as it turns out, there are actually two main entrances. On opposite sides of the freaking building. So, I continued to navigate my way into the bowels of the VA and eventually found where I was supposed to be. I met up with my mentor, and he took me to a little psych consult room where a couple of other junior/senior medical students were working on stuff. After reviewing the past history of the patient we were about to go interview, we went and found the psychiatrist (<i>whom we’ll call Dr. J</i>) my mentor was working with and my mentor introduced me to him. He seemed nice enough, perhaps a little eccentric. We started walking back through the maze of hallways while talking about the next case. Dr. J asked if I had been here before, and I said no. They both smirked – in a friendly, yet knowing way – and said, almost in unison, “Welcome to the VA.”</div>
<div>
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<div>
Huh.</div>
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<div>
As we were nearing the elevators, Dr. J turned back to me and said, “You’re welcome to take the elevators, but we take the stairs. We’re going to the 8th floor.”</div>
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<div>
Of course you are.</div>
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<br /></div>
<div>
I went along with it though, like a good little medical student. After we huffed and puffed our way up to the 8th floor (<i>I really need to do more cardio…</i>) we stopped at the nurse’s station. “We always catch our breath before going into a patient’s room,” Dr. J said, in between breaths.</div>
<div>
<br /></div>
<div>
After recovering there for a bit, we finally knocked on the patient’s room. He was a male in his mid-thirties who was, at the end of the day, a pretty normal guy. He had had a tough few years, though, with family members dying, a divorce, and some tough luck. He had apparently had some chest pain recently (which he had experienced before) and presented to the VA seeking help. They had started to rule out a cardiac etiology, though they still wanted to do a stress test. Dr. J was here to investigate the possibility of generalized anxiety disorder and/or panic attacks causing his symptoms.</div>
<div>
<br /></div>
<div>
In the emergency department, where I worked for two years before medical school, a “long” interview was maybe 15-20 minutes. Today, though, we spent almost an hour interviewing and talking about the patient, which my mentor said was fairly average. We sorted out how best to get him some help in the form of outpatient counseling and a little Ativan for the odd anxiety attack, and went on our way to check on another patient, who was on the second floor. This time, mercifully, we took the elevator. This patient was in surgical ICU while recovering from abdominal surgery. He had apparently been a bit delirious, mostly at night. Last night, he had ripped out his ostomy bag, making a mess. He also apparently was telling people that he was actually dead and didn’t know how he was talking to them.</div>
<div>
<br /></div>
<div>
Today, though, he seemed mostly normal. Mostly. In talking to him, you could tell all of his oars weren’t in the water, so to speak, but he had apparently decided that he was in fact alive now. That’s good. But we’ll keep you here just a little longer. And give you something to sleep at night.</div>
<div>
<br /></div>
<div>
After that, I headed out. I had a bunch of stuff on my plate to do that afternoon, mostly in the form of actual school work I needed to get through. Before I left the VA campus, though, I wanted to pick up my ID card that had taken forever to sort out. Back when we first started, we had to fill out an hours-long set of forms online for a background check and then get fingerprinted (<i>which took hours and hours of waiting in line at the ever-so-efficient VA HR department</i>) so we could get a government-issued ID for our rotations at the VA hospital in third year.</div>
<div>
<br /></div>
<div>
Turns out, though, the person in charge of handling the paperwork for my entire class left the VA while it was processing, and somehow all of our applications were forgotten about. And after sitting in some electronic holding vat for too long, the VA system terminated some of ours, depending on how long they had been sitting there. Those of us who had gotten them done early, for example. Like me. And, by the time they told us, our original fingerprints had expired. Lovely.</div>
<div>
<br /></div>
<div>
So I had gone back to HR a few weeks ago to get my fingerprints redone, and tried to figure out what was going on with the online forms. Someone took my name and said they’d figure it out and get back to me.</div>
<div>
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<div>
Which never happened.</div>
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<div>
I ended up calling the person in charge of “endorsing” us for our badges, who said don’t worry about it, we really didn't need that form anyway (<i>so we spent hours filling it out then because…?</i>). Your fingerprints are all you need for the background check. Go get your card.</div>
<div>
<br /></div>
<div>
Awesome. So, finally having a free moment from school, I thought that I’d run over to the ID card office and pick it up real quick. <i>Hahahahahaha……</i></div>
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<br /></div>
<div>
Turns out the office is in the middle of a seemingly mile-long building that stretches across the entire VA campus. And looks like it’s abandoned. And only has one entrance (that I could find) labeled “Suite C.” I needed Suite E. I couldn't tell where along the mile-long expanse to park, so I called the office number and asked them for some type of landmark. “We’re in building 1.”</div>
<div>
<br /></div>
<div>
Yeah, I got that.</div>
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<div>
“Oh, we’re at the north side of the building.” Great. So I drove to the north side of the campus/building…no entrance. <i>The frick</i>.</div>
<div>
<br /></div>
<div>
Drove back to Suite C. Parked. Went in. Was told to walk up a long hallway to Suite E. So I did, and finally found the office. Then I found out I wasn’t actually going to be able to pick up my badge, I actually needed to start the process. Which means more fingerprints and pictures. Buuuut the fingerprint machine wasn’t working – its server is busy. Can you use the extensive fingerprinting that I had completed at HR? No, our systems aren’t connected like that. Fine. Let’s try again. And again. And again. Let’s wait and see if the system suddenly becomes not busy. I did some <a href="http://www.dysgraphicmusings.com/2013/11/how-to-study-in-medical-school.html" target="_blank">Anki </a>while waiting. Try again. Wait again. More Anki. Try again. Wait again. Try again. Oh, let’s change this parameter – great, it’s fixed (an hour and a half later). Oh, remember those online forms you were told you didn't need? You actually do need it. We can’t give you a badge. Sorry.</div>
<div>
<br /></div>
<div>
as;ldkfjas;ldkfjasl;dfjasdl;fjkjdf</div>
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<br /></div>
<div>
So I walked back out of the building, toyed with going home and just doing the stuff I needed to get done, but decided that I’d better just go over to HR and sort out the online forms thing now and save myself a trip back to this dreadful place. So I walked over to HR, and actually ended up speaking to a lady there who was actually very helpful, which was a nice change of pace. She even stayed a little over her shift to sort things out, revived my forms from their electronic grave, dug some of my old paper forms that I had signed months ago out of some stack in a corner so I didn't have to go through them again, and got things moving again. I should be able to finally get my ID card in a few days.</div>
<div>
<br /></div>
<div>
I hope.<br />
<br /></div>
eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com0tag:blogger.com,1999:blog-2365930991142326796.post-89751008514028017532014-01-20T18:15:00.000-06:002014-01-22T14:45:43.685-06:00Frostbite<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Anatomy is finally over.</div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<o:p></o:p></div>
<br />
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Actually, it’s
been over for about a month now. We finished the week before Christmas, and
then went on a two-week break. Glorious break. <o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
My wife and
I flew home for Christmas to the West Coast (<i>the best coast, in my humble opinion…</i>) to spend it with our
families. The flight there and the time we spent with them was pleasantly
uneventful and relaxing. Then the effects of a so-called <a href="http://www.latimes.com/nation/nationnow/la-na-nn-polar-vortex-deep-freeze-20140106,0,6314452.story#axzz2qz0Osftp" target="_blank">polar vortex</a> hit the Midwest, wreaking havoc with our travel plans.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGw_y44T1dBwMrODkjkuFoChuiinlhHIltQmCaI_6wPEUhl1AIDPw71s6O5ldnOiBr2J2fBA12BUQozxX2IM0aoTih9SYZTmBhS44SzkPlEqDemQbpJhAvVxpYhyphenhyphene8MxMMFNzJHUumMxg/s1600/Frozen-Chicago-Pilot-Photo.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGw_y44T1dBwMrODkjkuFoChuiinlhHIltQmCaI_6wPEUhl1AIDPw71s6O5ldnOiBr2J2fBA12BUQozxX2IM0aoTih9SYZTmBhS44SzkPlEqDemQbpJhAvVxpYhyphenhyphene8MxMMFNzJHUumMxg/s1600/Frozen-Chicago-Pilot-Photo.jpg" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Image politely stolen from <a href="http://www.motherjones.com/blue-marble/2014/01/incredible-photos-polar-vortex" target="_blank">here</a></td></tr>
</tbody></table>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
We were supposed
to return home on an early-morning Friday flight. We pre-packed our stuff the
night before, woke up at the rather ungodly hour of around 3 am, made our way
to the airport, got our bags inside, made it half-way through the line to check
our bags in… and then one of the airline employees made her way towards the
line and started calling out, “If you are flying to Chicago, Denver, or New
York, your flight has been cancelled due to weather. Please call the 1-800
number to reschedule.”<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Well, darn. <o:p></o:p></div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
I dialed the
number while we were standing in line – the first of many times we would call
this number over the next few days, as we would soon find out. I was answered
by a machine and quickly put into an ever-growing queue. My wife tried calling as well, and actually
ended up getting through first. We were able to reschedule, but due to the
treacherous weather our destination was experiencing, the earliest flight we
could get on wasn’t till Sunday. <o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
So we hung
out for a few more days – sort of a forced vacation. At least we were able to
be with family, but we were both ready to get home. On Sunday morning, we repeated
our get-up-way-too-early-get-to-the-airport-get-in-line-check-to-see-if-the-flight-is-canceled-for-the-upteenth-time
routine. We checked in, checked the flight status board on the way to security,
made it through security, and were walking to our gate when we checked one of
the flight status boards again, just to be sure.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Cancelled. Again.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
We walked
down to the gate just to see what was going on – the flight had literally been
cancelled in the time it took for us to walk through security. This time we had
to somehow get our baggage back, and apparently the airline didn’t have any
standard procedure for this – one of the airline employees literally took a
vote among the would-be passengers that were present at the gate about how they
wanted their baggage returned (they ended up carting it to some office
somewhere in the airport where we could go pick it up). <o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
We again
tried calling the 1-800 number, and when we finally got through, the earliest
we could be rescheduled for was Wednesday afternoon – three days away. Argh.
Also, it turns out the airline we were flying on was the one airline that wasn’t
able to put their passengers on the flights of other airlines in case of
situations like this. <o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
By this
point, we just wanted to get home. We found a place with WiFi access, took out
one of our laptops, and searched for the soonest flight heading back home on
another airline. We would have pay a bit more to switch our tickets, but
whatever. We wanted to get back. We made the switch, but now we had to figure
out how to get our baggage. It turns out that, normally, if you made a
last-minute switch between airlines like this when you were already past
security, the airlines will just switch your baggage for you as well. But the
airline we were flying originally was, of course, the one airline that didn’t
do this. So, we walked back out, tracked down our baggage, got back in line to
check in our bags, went through security – again – and finally arrived at our
new gate, tired and slightly ruffled but happy to be finally heading home. <o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Of course,
this is all still at around 6 or 7 am in the morning. Our new flight didn't
leave till around 10 am, so we had a few hours to kill. We hung out, got some
food, read, and waited. Around 9:30, we were told that our flight would be
delayed for another hour. Ok, fine. We just wanted to get home at some point. <o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
We waited
around some more, and as the promised time drew near, another announcement was
made: we were delayed again. We ended up being delayed four times, but after
spending about nine hours in the airport we finally were able to board the
plane and make it home. Just in time for record-breaking subzero temperatures. At
least school was cancelled that Monday, which was nice.<o:p></o:p></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Our first
day back, it was around -15 degrees Fahrenheit with a wind chill of around -30
to -40 degrees. We, of course, didn't get the memo and decided that we should
go shopping before the week started. That was fun – particularly the part where
I almost lost a couple of fingers (<i>ok,
not really, but I definitely reached the early stages of frostbite…</i>) trying
to uncover our buried cars, one of which didn't even start up for a couple of
days (<i>till it warmed up – relatively
speaking – to around 25 degrees, anyway…</i>). We had a pipe freeze, too, which
thankfully didn't burst. That would have been a bummer. <o:p></o:p></div>
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School
started up again that Tuesday. We started our physiology class, which will run
for the rest of the semester. Now (a little over two weeks later), we've just
finished our cardiac physiology section, which was really quite interesting. It’s
quite the organ. We also learned how to interpret EKGs, and it’s amazing how
much information can be derived from all of those bumps and squiggles. We also
took our own EKGs, and apparently my heart is actually pointing almost straight
down in my chest – most people’s hearts point down, left, and towards the
front. The things we learn in medical school.<o:p></o:p></div>
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Oh, and
apparently we have <a href="http://www.chicagotribune.com/news/local/breaking/la-na-nn-polar-vortex-sequel-20140118,0,1739599.story" target="_blank">another cold front</a> coming in tomorrow. Chicago, we love you too.<br />
<br /></div>
eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com0tag:blogger.com,1999:blog-2365930991142326796.post-70793071226500644592013-12-13T15:15:00.000-06:002016-03-20T11:25:49.305-05:00My Personal Statement<i>Note: One of the more time-consuming and difficult things you must complete for your medical school application is a personal statement. It essentially provides an opportunity for you to tell admission committees who you are, what you value, why you want to be a doctor, what makes you different from the thousands of other applications, and anything else that doesn't really fit into the tidy little boxes on your AMCAS application. It’s an important part of the application for all schools, and a crucial part for some. Outside of your transcripts and whatnot, this is your only chance to convince the school to consider you for an interview.</i><br />
<br />
<i>I briefly wrote about how to formulate a personal statement <a href="http://www.dysgraphicmusings.com/2013/05/thoughts-on-getting-into-medical-school.html" target="_blank">here </a>in the “How to Get into Medical School” series. One of the more difficult parts of writing it, for me, was not really knowing what it was even supposed to look like as a finished product. With that in mind, I've decided to post mine here – not that this is the only way to do it, by any means, but it’s one way. Whatever you end up writing, you'll most likely think it's the most amazing thing at the time, only to cringe when you look at it several years later (little heavy on the melodrama in mine, I think...). Regardless, I hope that it might help point some of you who are trying to compose your PS in the right direction. Good luck.</i><br />
<br />
Death was no stranger to me. But this one was different--I knew her. I was working in the patient transport department in a large hospital in Portland. I was new, and only had been working for about a month and a half. It was the middle of a moderately busy Friday evening shift. I sat down to rest my weary feet and to pick up a new job over the phone system. An automated voice came on the line, telling me to take a patient named Katie from the seventh floor to the morgue. My heart sank. I knew this woman. I had recently transported her, and even though she was in the hospital and obviously sick, she hadn't struck me as someone who was on death's doorstep. She was young--not even forty. Yet here I was, picking up her morgue job. I hung up and reached for the morgue key. The key was attached to a trapeze handle, apparently to make it easy to find. Most of the trapeze handles in the hospital were bright colors. This one was black. Fitting, I suppose. I left the transportation office, obtained a gurney and a blue tarp to place over the former patient, and began the long walk to the seventh floor of the hospital. The seventh floor, by the way, was the Oncology unit. Katie had died of cancer.<br />
<br />
Death hadn't really bothered me until Katie. But Katie was different. Cancer had struck her down when she had so much life left. And even though I had not really known her, I had cared for Katie and talked with her. She had, to me, been a real person, while the cadavers in anatomy lab and bodies of other patients had been anonymous. They had lived their lives, of course, but I had not been a part of that. With Katie, I had. Who could have known, on that day that I transported her just a few weeks ago, that I would later wheel her dead body to the hospital morgue? Sorry, Katie. We have failed you. Cancer has won this battle.<br />
<br />
This was not the first time I had encountered this sense of helplessness. A few years before Katie, I had the opportunity to travel to Africa. While I was there, I was mentally wrestling with myself about the future. When I was younger, I thought I would go into law. The idea of being presented with an issue, thinking through all aspects and perspectives, and then using logic and argument to debate for one side appealed to me. The thrill of the contest seemed to provide a rush like nothing else. However, in my first college English class, we were assigned to write the quotidian research paper. I chose to focus on the medico-legal aspects of stem cells. Although here again I found the excitement of laying out all sides and making my case, there was something new here. The potential capabilities of stem cell applications in particular, and medicine in general, contained within themselves the possibility not only of captivating intellectual opportunities, but the real ability to radically change people's lives in a tangible way. It was then that this usurper of my attention, medicine, entered into my life. I knew it had the potential to cause change, and in Africa, I saw the great need for just that. We spent some time in Kibera, the second largest slum in Africa. People were living in huts built from sticks and mud. Hygiene was poor--walking along the narrow roads between huts, it was generally best to not dwell on what was underfoot. There was no running water, no formal sewage system. Disease, including HIV/AIDS, was widespread. Change was needed here. These people needed social help, political help, economic help--but first, they deserve at least to live. To not be plagued daily by easily preventable diseases. Medicine was necessary for this to become reality, to begin to effect lasting change--and I deeply desire to play a part in this.<br />
<br />
A year later, I was working as a lifeguard back in the United States. It was here that I experienced a rudimentary exposure to medical care, particularly emergency medicine. The thrill I thought I had found in simple debate was exponentially replaced by the high that came from being presented with an acute problem, whether a simple injury or a drowning patron, accounting for a number of factors that play into the situation, and responding in a way that effected, often, a measurable relief. I thoroughly enjoyed it. To further explore this, I volunteered in a local emergency room, became trained as an EMT, and worked as an ED Scribe. The more I traveled into the realm of medicine, the more hooked I became. But in all these positions, the limited level of care I was able to provide bothered me. I wanted to be able to do more for those I cared for.<br />
<br />
The majesty and brokenness of our inner workings have always intrigued me. But what was crystallized for me in these experiences was a deepening of my desire for change; an urge to take up the weapons of medicine and join in this bittersweet war between life and death--the ultimate debate. Death is sometimes an ally, but all too often an enemy. I want to fight for those like Katie, for those who live in Kibera, and for those whom Death strives to take too soon after they have lived lives of despair. This is a war that must be fought on many fronts, but one that I desire to fight as a doctor.eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com0tag:blogger.com,1999:blog-2365930991142326796.post-21241533826265695202013-11-02T21:44:00.001-05:002015-04-22T19:39:25.122-05:00How to Study in Medical School<!--[if gte mso 9]><xml>
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</xml><![endif]-->In an <a href="http://www.dysgraphicmusings.com/2013/06/how-to-spend-summer-before-medical.html" target="_blank">older post</a>, I wrote a little bit about my search for efficient study tools for medical
school, and how I eventually discovered Anki and OneNote. To briefly summarize,
I spent part of the summer before school started trying to figure out how I was
going to study. I knew it would be a different ballgame than undergrad (and
that turned out to be true), so I figured my old methods wouldn't work so well (which would also be true...).
In undergrad, I usually just went to class, took notes in a binder, read any
assigned reading, and reviewed everything once or twice in the day or two
before the exam, depending on the class. For medical school, though, I knew
that I would need a way to take in more information, organize it, and review it
more than once or twice. <br />
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After poking around the internet a bit, I settled on Microsoft’s OneNote to
take notes (if you have a PC, I highly recommend this program. If you have a Mac, I don't think it's available. I have heard good things about Evernote,
though, which is available on both platforms. That said, I prefer the
organizational structure of OneNote over Evernote – both are good programs,
however). This was a great way to 1) cut down on what I actually had to lug around 2) organize everything in one searchable, legible database (this latter point is important, as my handwriting is chicken-scratch) 3) and take more
notes much more quickly than I could write them, while also incorporating
various media as needed.</div>
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Below is a
great video describing how one can use OneNote in medical school. Everyone
might do things slightly differently, but this provides a good starting point. </div>
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<br />
Note: These aren't my videos, but I think they give a great overview of how to use OneNote and Anki.</div>
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If you have
a Mac, then I’d suggest checking out Evernote. <a href="https://managingmedicine.wordpress.com/evernote/" target="_blank">Click here</a> for a
basic overview of how to navigate Evernote. </div>
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If you used
paper in undergrad, like I did, you might think that you’d rather just keep
doing that. And that’s fine. But if you can, I’d really recommend switching to
a computer-based note-taking program. I have found it to be much faster and
more efficient. It allows me to pretty much have access to every note that I
have taken at all times, search the entire database, and sync it all in “the
cloud” so that, if I were to lose my laptop, I could be up and running on any
other computer in the time that it takes me to log in to SkyDrive. OneNote’s
built in screen-capture feature is also a very helpful tool that I use on a
daily basis. </div>
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So I had a
good way of taking notes. Great. But how would I review them? It is a common
refrain among medical students that you can expect to forget pretty much
everything you learn in the first couple of years. That may be true, but that
didn’t sit well with me. I’m sure most of what we learn is irrelevant, and that’s
fine, but not all of it is, and a large chunk of what we are learning we’ll
have to know for the boards. So I started to wonder if there was a way around
that…and found Anki. </div>
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Anki is
essentially a free flashcard program. You create the cards, review them, and
then the program will use a spaced-repetition algorithm that makes certain
cards due at various intervals, depending on how well you could recall the
information. (Update: I've written a brief Anki Q&A <a href="http://www.dysgraphicmusings.com/2014/03/anki-q.html" target="_blank">here</a>.)</div>
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So, for
example, you make a card. Right after making the card, you review it. It’s
pretty easy, and you answer it correctly. The next day, the card is due again.
Again, you answered it pretty easily, so when Anki gives you the option of
choosing how well you recalled the information (generally something along the
lines of “again,” “hard,” “good,” or “easy,” with each option being associated
with a certain default time interval, like “10 minutes,” “2 days,” “3 days,” or
“4 days,” respectively), you select “good.” In three days, the card becomes due
again. If you again select "good," this time the time interval might be “5 days,”
and so on and so forth. </div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_rxzJnqHlyL5P6yVfvYY5qYEwL4-bqaoduJR2khhFMJ5KLhQo6QeCVfTaKPhseEURgBhUCnTxxFBwlTRf5LzkRtiw9g94PAuy0DdOdpLWeWYs2rKfNosEBQHog9harhe7VUhvZU73PaA/s1600/forgetting_curve.png" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_rxzJnqHlyL5P6yVfvYY5qYEwL4-bqaoduJR2khhFMJ5KLhQo6QeCVfTaKPhseEURgBhUCnTxxFBwlTRf5LzkRtiw9g94PAuy0DdOdpLWeWYs2rKfNosEBQHog9harhe7VUhvZU73PaA/s400/forgetting_curve.png" height="250" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Taken from <a href="http://www.learnthat.org/pages/view/wrong-answer.html" target="_blank">this random website</a></td></tr>
</tbody></table>
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You can see
in the graph how this works out over the long term. After we learn something,
that knowledge immediately begins to decay. However, we can slow that knowledge
decay by exposing ourselves to that information again within a specified window
of time. Over time, this spaced review strengthens the memory of whatever it is
we are trying to recall. Sounds great… but the trick is to figure out when we
need to review the information. With physical flashcards, this quickly becomes
tedious (especially when you accumulate thousands of flashcards...). With notes, we might review those a few times before a test, but then
probably never really look at them again. With Anki, you don’t even have to
think about it. Anki does all of the work, and uses your answers (whether the
card is hard, good, or easy, for example) to create a personalized scheduling
algorithm for you. </div>
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So how do
you use this in school? There are many different ways to use it, but I’ll
briefly walk through how I’ve been using it. After lecture, I review my notes
and find important concepts, ideas, or minutia that I feel I need to know. It’s
important here to distinguish between things that only the professor would ever
ask, things that you might actually need to know for boards, and things that
you simply find interesting and/or helpful. For the most part, you only want to
make cards for things that fall into the last two categories. That said, you
can make cards for things in the first category and “suspend” them after the
test – that way, you reap the benefit, at least in the short term, of spaced repetition
while avoiding making your daily reviews in the long term too long. </div>
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I would
recommend trying to only make 20-50 cards a day (ideally), with an upper limit
of 100 new cards per day. When making new cards, there are some rules that you
should keep in mind about how to make efficient cards – <a href="http://www.supermemo.com/articles/20rules.htm" target="_blank">you can (and should) read them here</a>. If the cards that you make are junk, then Anki will not be
beneficial for you. Right after you make the cards, be sure to review them. Additionally, it can be helpful to tag the cards as you make
them – so, for example, if you are making cards about the upper extremity in anatomy,
you can tag them all under “upper_extremity” so that you could pull all of those
cards out later for a dedicated review, if you so desired. You can also tag by
source – for example, if you wanted to check what you are learning in your
classes against a gold-standard source like First Aid, you can tag any info
that is in First Aid with an appropriate tag so that you can review it later or
just to remind you not to suspend that card down the road. Again, while it
would normally be a waste of time to look at a source like First Aid in your
first year, with Anki this is no longer true, because you will actually
remember the information. Ideally, this will help you later when you do begin
to study for boards.</div>
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<br /></div>
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There are
also different types of cards you can make. You can make straight flashcards
(e.g. prompt on front, answer on back), you can use something called cloze
deletions, or you can use image occlusions. There are many other types of
cards, but these are the three types that I primarily use. </div>
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<br /></div>
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Cloze
deletion and image occlusion are powerful tools, and are perhaps best
illustrated by video. So below are some relevant videos that provide a short
introduction to how to use Anki and create those types of cards. I highly
recommend taking the time to watch them. </div>
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<iframe width="320" height="266" class="YOUTUBE-iframe-video" data-thumbnail-src="https://i.ytimg.com/vi/nrHsCUwKqps/0.jpg" src="https://www.youtube.com/embed/nrHsCUwKqps?feature=player_embedded" frameborder="0" allowfullscreen></iframe></div>
<br /></div>
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<br /><iframe width="320" height="266" class="YOUTUBE-iframe-video" data-thumbnail-src="https://i.ytimg.com/vi/2xYWIv8ksqg/0.jpg" src="https://www.youtube.com/embed/2xYWIv8ksqg?feature=player_embedded" frameborder="0" allowfullscreen></iframe></div>
<br />
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Now you’re
ready to get started. Go <a href="http://ankisrs.net/" target="_blank">here</a> to download
Anki, and <a href="http://ankisrs.net/docs/manual.html#intro-videos" target="_blank">here</a>
to see the user manual if you have any other questions – although, if you’ve
watched the above videos, you should have a pretty good handle on things. </div>
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Finally, if
you ever have any problems with Anki, following the instructions in the video below
should fix them.</div>
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Once you’ve
made the cards, make it a point to review them daily. Just get it done – you’ll
be glad you did later. It might take a little more time up front to create the
cards and spend time reviewing them, but when it comes time for a test, I think
you’ll find that you’re a bit less stressed about it and are able to spend less
time trying to cram information in your head. Usually for tests I just
passively review my old notes once – quickly – just to get a “big picture” review
and to go over anything I specifically marked as something I should review (for
example, if I didn’t put something in Anki because it is important for the test
but for absolutely nothing else in life). </div>
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Also,
reviewing them can be done on the go. There is an Anki app for both Android (free)
and iPhone (not free, but worth it). For example, I start reviewing cards in
the morning while eating breakfast, while walking from the parking garage to
school (which would otherwise be a waste of 5-10 minutes, and during which time
I can get through a bunch of cards), in between classes, etc. This allows me to
sometimes be completely finished with my daily review by the time I get home,
or at least have a significant portion of it knocked out. </div>
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So that’s
OneNote and Anki. These are very powerful tools. There are, of course, many
ways to get through medical school, but, at least for me, these programs have
single-handedly gotten me this far, and I plan on continuing to use them throughout
the rest of school. <span style="mso-spacerun: yes;"> </span></div>
eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com9tag:blogger.com,1999:blog-2365930991142326796.post-39793036121238704472013-10-26T15:14:00.001-05:002013-10-26T15:34:14.092-05:00Rite of Passage<!--[if gte mso 9]><xml>
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survived.
<br />
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The first
anatomy exam is over. </div>
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*insert sigh
of relief here*</div>
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<a href="http://www.dysgraphicmusings.com/2013/10/the-stare-of-death.html" target="_blank">As I wrote about previously</a>, Loyola just changed up their anatomy curriculum.
Most of the changes, at least in my opinion, are for the better. The one change
that we were all nervous about, though, was the switch from in-lab anatomy practical
exams (where you wander around in the anatomy lab and try to identify labeled structures
on cadavers) to online practical exams (where the instructor takes a picture of
the labeled structure, and you have to figure out what in the world you are
looking at). <br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhy5EOIewSSz0YixUrKRQVSO4TOZxpr5LZBNGG0HGqLhBitySmctS-TQqEIIWpdtHhKNQsJcOL41-sryUOD907mV9Ov_nbyU2H2sLB-b8jncQsWTanwENYI9OqumunCNWPpmNDM6eOmZ2E/s1600/anatomylab_nd_3.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="277" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhy5EOIewSSz0YixUrKRQVSO4TOZxpr5LZBNGG0HGqLhBitySmctS-TQqEIIWpdtHhKNQsJcOL41-sryUOD907mV9Ov_nbyU2H2sLB-b8jncQsWTanwENYI9OqumunCNWPpmNDM6eOmZ2E/s400/anatomylab_nd_3.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">From <a href="http://www.ohsu.edu/xd/education/library/about/collections/historical-collections-archives/exhibits/anatomy-at-the-bleeding-edge.cfm" target="_blank"><i>Anatomy at the Bleeding Edge</i></a></td></tr>
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</div>
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Intuitively,
it seems like an in-lab practical would be the better course. With anatomy, it’s
often helpful to be able to orient yourself to the region of the body you are
in and look at a labeled structure from several different angles while you are
figuring out what it is. With a picture, on the other hand, we were afraid that
we wouldn’t really be able to orient ourselves or see the structure clearly.
Looking at pictures of a cadaver can be an entirely different experience than
seeing one in the flesh (<i style="mso-bidi-font-style: normal;">I know, that was
too easy…</i>). In fact, having done a couple of online practical exams as
practice before the test, I know all too well that badly-taken pictures can be
downright frustrating. </div>
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Despite all
of that, the general consensus among the students – and I agree – was that the
instructors did a great job in creating the online practical. All of the
pictures were of good quality, structures were pretty clearly labeled, and they
did a good job of orienting us to the region by showing us where exactly in the
body we were and making an effort to clearly show neighboring structures.</div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
There was
also the benefit of being able to take your time while trying to identify a
structure. I took anatomy in undergrad (<i style="mso-bidi-font-style: normal;">and
subsequently forgot everything…but ah well</i>), and we had in-lab practical
exams. These generally consisted of a large mass of students wandering somewhat
aimlessly around a locked-down laboratory with a sheet of paper, a clipboard,
and a pen. While it is helpful to be able to look at a given structure from
multiple angles, at the same time you did feel somewhat rushed by the bolus of
students coming down the line behind you. With the online practical exams,
however, you could stare at that darn picture however long you pleased, thank
you very much. So that was nice.</div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
I was pretty
happy with the results of the exam. The class as a whole did pretty well,
actually. <a href="http://www.dysgraphicmusings.com/2013/06/how-to-spend-summer-before-medical.html" target="_blank">Anki</a>
really shines in anatomy, particularly the <a href="https://www.youtube.com/watch?v=2xYWIv8ksqg" target="_blank">image occlusion</a> feature,
which allows you to screen-capture a picture from your computer, cover labels,
and quiz yourself using Anki’s spaced-repetition algorithm. Since anatomy is
all about visual recognition/spatial thinking, Anki is perfect for this
subject. It’s much better than staring at a picture in a textbook until you
think you have it, only to forget it a week later. </div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
As far as
studying for the test – and anatomy in general – goes, I really didn’t spend
much time in lab. I generally attended lecture, which I found to be helpful,
and then came home and made Anki cards for what we learned that day from
lecture slides, Thieme’s <i style="mso-bidi-font-style: normal;">Atlas of Anatomy</i>
(which has some beautiful pictures), our online dissector (which has a lot of the
Thieme pictures), or one of the Lippincott <i style="mso-bidi-font-style: normal;">Concise
Illustrated Anatomy</i> books (which comes with an access code for on online
version of the book on a great e-book platform – awesome for making cards). Also,
before or shortly after starting a new region of the body, I tried to watch the
relevant <a href="http://aclandanatomy.com/" target="_blank">Acland’s Anatomy videos</a> –
these videos are beautiful prosections of very well-preserved cadavers (which
are much more helpful, in my opinion, for understanding what the structures
actually look like than studying from a dried-up cadaver).<br />
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
</div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Those are my
primary study sources. I may occasionally glance through <a href="http://www.amazon.com/gp/product/1605477451/ref=as_li_tf_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=1605477451&linkCode=as2&tag=dysgramusing-20" target="_blank">BRS Gross Anatomy</a><img alt="" border="0" height="1" src="http://ir-na.amazon-adsystem.com/e/ir?t=dysgramusing-20&l=as2&o=1&a=1605477451" style="border: none !important; margin: 0px !important;" width="1" /> or
play around with this <a href="https://www.biodigitalhuman.com/" target="_blank">awesome (and free) 3D anatomy visualization website</a> – one of the reasons it’s so great
is that you can actually dissect away certain structures, which is awesome for
getting a handle on three-dimensional relationships of otherwise
hard-to-visualize structures. </div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;">
<iframe frameborder="0" marginheight="0" marginwidth="0" scrolling="no" src="http://rcm-na.amazon-adsystem.com/e/cm?t=dysgramusing-20&o=1&p=8&l=as1&asins=1604067454&ref=tf_til&fc1=B14008&IS2=1&lt1=_blank&m=amazon&lc1=FF5400&bc1=000000&bg1=FFFFFF&f=ifr" style="height: 240px; width: 120px;"></iframe><iframe frameborder="0" marginheight="0" marginwidth="0" scrolling="no" src="http://rcm-na.amazon-adsystem.com/e/cm?t=dysgramusing-20&o=1&p=8&l=as1&asins=1609130278&ref=tf_til&fc1=B14008&IS2=1&lt1=_blank&m=amazon&lc1=FF5400&bc1=000000&bg1=FFFFFF&f=ifr" style="height: 240px; width: 120px;"></iframe><iframe frameborder="0" marginheight="0" marginwidth="0" scrolling="no" src="http://rcm-na.amazon-adsystem.com/e/cm?t=dysgramusing-20&o=1&p=8&l=as1&asins=1609130286&ref=tf_til&fc1=B14008&IS2=1&lt1=_blank&m=amazon&lc1=FF5400&bc1=000000&bg1=FFFFFF&f=ifr" style="height: 240px; width: 120px;"></iframe><iframe frameborder="0" marginheight="0" marginwidth="0" scrolling="no" src="http://rcm-na.amazon-adsystem.com/e/cm?t=dysgramusing-20&o=1&p=8&l=as1&asins=1608313832&ref=tf_til&fc1=B14008&IS2=1&lt1=_blank&m=amazon&lc1=FF5400&bc1=000000&bg1=FFFFFF&f=ifr" style="height: 240px; width: 120px;"></iframe><br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
One of the many
things I like about Anki is that, in the days leading up to the test, I wasn’t
spending time learning stuff. I already knew (or at least had seen) the
structures we needed to know, because I had been reviewing them according to
the spaced repetition algorithm on a daily basis. Instead, I was able to spend
time doing the relevant <a href="http://www.med.umich.edu/lrc/coursepages/m1/anatomy2010/html/courseinfo/mich_quiz_index.html" target="_blank">written and practical exams on the University of Michigan Medical School’s website</a>,
which is an incredible (and, once again, free!) resource. It really helped tie
certain concepts together in clinical scenarios, while at the same time giving
me a rough idea of what the online practical format would be like (<i style="mso-bidi-font-style: normal;">although, some of the pictures were rather
frustratingly unclear…</i>). I did make an effort to do a passive once-over my
lecture notes, just to have one last integrated exposure to all of the material
and also to review anything that I hadn’t deemed worthy of “Anki-fying.” Finally,
I also reviewed any relevant sections of Rohen's <a href="http://www.amazon.com/gp/product/1582558566/ref=as_li_tf_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=1582558566&linkCode=as2&tag=dysgramusing-20" target="_blank">Color Atlas of Anatomy</a><img alt="" border="0" height="1" src="http://ir-na.amazon-adsystem.com/e/ir?t=dysgramusing-20&l=as2&o=1&a=1582558566" style="border: none !important; margin: 0px !important;" width="1" /> to get an idea of what the beautiful illustrated pictures in Thieme and
Lippincott actually look like in “real life.” </div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
It was only
the day before the test that I actually went down into the lab, which marks the
second time I’ve been down there since anatomy started a few weeks ago (the
first time was the dedication ceremony for the cadavers). While it can be
enlightening to see first-hand what certain structures look like and how they
interact with other structures, what you’re looking at in lab is not the best representation
of what things look like in real life (Acland’s videos do a much better job, I
think). Nevertheless, the anatomy lab is somewhat a rite of passage for medical
students, and besides, these are the cadavers that most of the pictures for the
practical are coming from. I spent maybe three or four hours in lab, reviewing
stuff with other students as we quizzed each other. Some fourth years are also
participating in the course as part of a fourth-year anatomy elective and also
gave some great mini-reviews. Finally, we have what our professor calls “Magic
Pens” (no idea what they are actually called) that are essentially electronic
pens with speakers in them. You can tag a body part with a special tag, and the
pen will read the tag and play back a recording of whatever the professor
wanted to record about that body part. These were helpful for solo-review,
since it can otherwise be frustrating trying to pick out various muscles,
arteries, and nerves out of something that, a few weeks into the course, looks
less like a human being and more like road kill. </div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
One of the
biggest challenges of anatomy is figuring out a study routine that works well
for you. Each student will learn differently. Another one of the big challenges
is sorting through the mountain of information presented to you, organizing it
in a way that makes sense, and memorizing it. I feel like the tools above help
me do that, and it seems to have paid off. I’ll continue using these resources
for the next test, and hopefully things will continue to go ok. We shall see.
Meanwhile, my dissection rotation is coming up – I get to do the thorax and
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<![endif]-->We start on
Halloween – fitting, I suppose.</div>
eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com0tag:blogger.com,1999:blog-2365930991142326796.post-63444020514032705832013-10-11T23:24:00.000-05:002013-10-12T12:27:25.516-05:00The Stare of Death<!--[if gte mso 9]><xml>
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
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<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
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<w:LsdException Locked="false" Priority="19" QFormat="true"
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<w:LsdException Locked="false" Priority="31" QFormat="true"
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<w:LsdException Locked="false" Priority="32" QFormat="true"
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<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
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<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
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<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
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<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/>
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</o:shapelayout></xml><![endif]-->I’ve been on
fall break for the past week…and it’s been glorious. Loyola starts a little
early, but that translates into a week-long break halfway through the first
semester. Which is most excellent – and much needed. It’s been a long few
months. My wife and I have spent the break basically trying to be as non-productive as
possible (i.e. watching a ton of old movies that we watched as kids, eating ice
cream, and occasionally doing more big-person things like shopping, home repairs,
etc.). We’ve had a blast.<br />
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJngGgDU1FrlvCpVN-ObnrfxdoR9CGv4OaJvSRUyUAMrXNBnyEbb5DrBVzVdSy4Gi8yFMWukbq2NnnNdqQa_6Laav4PvPDdEh8M_1pc71GJ4cRM_r-YeEK2K_cDP14_sj8Z7vzArJZZjM/s1600/baby+pic.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="291" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJngGgDU1FrlvCpVN-ObnrfxdoR9CGv4OaJvSRUyUAMrXNBnyEbb5DrBVzVdSy4Gi8yFMWukbq2NnnNdqQa_6Laav4PvPDdEh8M_1pc71GJ4cRM_r-YeEK2K_cDP14_sj8Z7vzArJZZjM/s320/baby+pic.png" width="320" /></a></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
We also got to go to
our first ultrasound, which was awesome. My wife is <a href="http://www.dysgraphicmusings.com/2013/09/paradigm-shifts-puppy-therapy-and.html" target="_blank">twelve weeks along now</a>, and he?/she? is starting to look like a little human
being. It was quite the moment when we got to see our child moving around,
kicking, and generally looking cute on the ultrasound screen. Just because I
can’t resist, here’s one of the pictures we were given to take home with (<i>awww....</i>). His/her feet kind of look like claws in this view, actually. But
they’re really quite normal – we checked. I may or may not have tried to count
his/her fingers.</div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
But, alas,
break is soon going to be over, and back to the grind we go. We started anatomy
a few weeks ago. It’s actually been really interesting, but it’s also been
really, really busy. The tried-and-true fire hose analogy that people use to
describe the volume of information coming down the pipe at you in medical
school – all of which you have to know, and know well – continues to be proven
true, if not even more so than before. </div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Loyola
actually recently changed up their anatomy curriculum. Their overall goal was
to cut down on required time slogging through excess adipose tissue in the lab
and increase the time that students had to master the material on their own.
Personally, I’m a fan of that goal. Dissection is an awesome experience, and
somewhat of a rite of passage for doctors-in-training, but it can nevertheless
be somewhat of a drain on one’s limited amount of time. So, instead of having
close to twenty bodies for the class and everyone in the lab at once with only
a few instructors to go around, they’ve cut the body number down to six, posted
a faculty member at each table, and split the class up into rotations, with
each rotation dissecting a certain region of the body. I was assigned to the
thorax and abdomen, which should be interesting. Students can, by the way, go
down whenever they want, but only absolutely have to be there during their
rotation. Additionally, instead of making us sit in lecture, they’ve tried to
summarize the key points of lectures in short-ish videos that we’re supposed to
watch before coming to class (which, during anatomy, only goes for about an
hour or two max – which has been awesome). During class, the idea was that we’d
go over board-style questions that made us really think through the relevant
material to arrive at an answer.</div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
There have
been a few glitches in the execution of their new curriculum, however. The
biggest issue has been with the videos and “lectures.” Unfortunately, trying to
pare down anatomy to a few “key points” leaves a lot missing. It’s difficult to
then go forth and memorize crap when we really don’t know where to stop – we
could, of course, go on memorizing forever (<i style="mso-bidi-font-style: normal;">and,
being the neurotic medical students that we all are, we would</i>). We really
didn’t know where to stop. Additionally, we were supposed to watch these videos
the “night before” the “questions lecture,” which really gives us no time to
process and learn the information…which means that the lectures really turned
into a waste of time, since we had no idea what we were supposed to be doing.
Finally, some people weren’t happy about the change in lab setup – I remember
one of the questions that always seemed to come up in tours of the schools on
interview day was something along the lines of “What’s your student-to-body
ratio?” (<i style="mso-bidi-font-style: normal;">As an aside…this really isn’t
all that important. Really.</i>)</div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Thankfully,
Loyola is pretty responsive to its students. We had a Dean’s forum, where we
basically were given free food and were able to ask the Dean of the school any
questions that we had. Anatomy was a hot topic. We all expressed some of the
above concerns, and within a few days we started to see some changes. First,
the “question lectures” became more “lecture-ish.” This was actually the most
helpful change, in my opinion, as it’s nice to have someone walk you through
certain things that don’t come as easily from a short video or staring at a textbook.
Next, the professor produced a more definite list of what we should focus on.
Finally, for those students who wanted more lab time, the professor started
doing short, daily reviews in the lab of the previous day’s dissection, just so
we can see things on an actual human body instead of simply in pictures and to
save us the pain of going down on our own and trying to pick through things. So
far, I think things are shaping up for the better – we’ll see how things go. </div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
I have had a
few opportunities to get out of the classroom, though. One of the things I did
was volunteer at a free clinic in Chicago that Loyola students basically take
over for one night a week. First year medical students essentially observe,
might take a history, and pretend to listen to heart and lung sounds. Second
year medical students, on the other hand, really get to run the show – they’ll
interview the patient, examine them, come up with a plan of treatment, present
the case to an attending, talk it through with them, and write a note. It’s
really a great opportunity to get out of class and use some of the skills we
are learning. So far, first years have only covered the patient interview and
spent some time interviewing standardized patients, but as the year progresses
we’ll learn more physical exam skills. That should be fun, and the clinic
should be a great place to practice and take a break from class.</div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Loyola’s
anesthesiology interest group <span style="mso-bidi-font-weight: normal;">also has a
program called APEP, or Anesthesiology Preceptorship Enrichment Program</span>.
It’s essentially a program that pairs students up with an anesthesiologist
mentor with whom they meet once a month for a few hours during the
anesthesiologist’s shift and discuss some basic science concepts in the
operating room. It’s a great way to translate some of our bookwork to the real
world. I’ve met with my preceptor once so far, and had a great time. We talked
about different sedation methods, intubation, difficult airways – and there was
mention of a possible opportunity to intubate in the near future. That’d be
fun. The program isn’t just for students interested in anesthesiology. I
personally didn’t have a huge interest in it coming in to medical school, but I
do want to explore different specialties and see what’s out there. Also, it’s a
great opportunity to spend some time in the hospital and learn some practical
stuff that one might not get through a lecture.</div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Finally, I
was able to spend an afternoon shadowing an emergency physician. Since I worked
for a few years in or around an emergency department before medical school, and
this is the specialty I have had the most exposure to, it’s also the specialty
I’m most interested in at this point (<i style="mso-bidi-font-style: normal;">supposedly,
I’m supposed to change my mind about this at least twelve-bazillion times in
the first couple years. Or so I’m told. I’m sure I probably will</i>). It was a
good shift – it’s different being introduced as a medical student and getting
the opportunity to participate more in the patient’s care. As a scribe, I was
used to <a href="http://www.dysgraphicmusings.com/2012/10/can-i-get-you-wheelchair_31.html" target="_blank"><span style="mso-bidi-font-weight: normal;">standing in the corner</span></a> and writing
down what was going on. Now, I actually get play some small role, and that’s a
lot of fun. </div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
About
halfway through the shift, we heard the EMS radio come on. Through the static,
we gathered that there was a full code about to come through the door. The
usual calm before the storm ensued – people began to prepare one of the trauma
rooms and gather around the stretcher, double-checking their equipment and
wrestling their uncooperative gloves onto their hands. Then the double doors to
the ED flew open and a stretcher came through. It was being guided by two
people with another person trying their best to continue chest compressions
while walking alongside the stretcher. I didn’t catch most of the story,
although it didn’t sound like there was much of one – male in his mid-sixties,
found down. CPR started at the scene, epinephrine given just outside the ED
doors, no response. </div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
The doctor I
was shadowing didn’t have this patient, but followed the stretcher into the
room to see if the other doctor on wanted a hand. My scribe instincts kicked
in, and I started to look for a corner to stand in and stay out of the way.
Before I found one, though, she motioned me to follow her in and threw me a
pair of gloves. The poor soul who had walked in beside the stretcher doing
compressions had been relieved by fourth year medical student who was rotating
through the ED, but he was starting to look a bit fatigued. Before I knew it, I
was standing over a very dead-looking patient, bouncing up and down on his
chest, and trying to keep time to <a href="http://www.youtube.com/watch?v=I_izvAbhExY" target="_blank"><span style="mso-bidi-font-weight: normal;">“Stayin’Alive”</span></a> in my head. </div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
This was my
first time doing CPR on a real person. The first thing that struck me was how
everything seemed to slow down a bit. There was plenty of time to think. The
second thing that struck me was how grey the fellow looked. After that, I was
surprised by how “rubbery” his chest felt – somehow, I didn’t expect the rib
cage to have that much rebound. Finally, I quickly started thinking that I
really should do more cardio – compressions are exhausting!</div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
The doctors
did a great job of making it a teaching experience. They showed me and the
other students where to check for a pulse to make sure that the compressions
are effective, and after using ultrasound to check for cardiac activity, walked
us through what they were looking for and what showed up on the ultrasound. It
was really interesting. They also made sure I saw the “fixed and dilated
pupils” – the stare of death. That was…weird. It really was a truly empty gaze.
With cadavers, their eyes are usually closed. It was different staring into
the eyes of a person who, moments ago, might have been thinking about what they
were going to eat for dinner that night. </div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
The gentleman
didn’t make it. Or, more correctly, he stayed dead. And life went on. We went
and saw another patient, the body was prepared for viewing, and…that was it. I
had seen people die before, but this was the first time I had really been
involved in their care. That said, it really wasn’t <i style="mso-bidi-font-style: normal;">sad</i> so much as it was more of a <i style="mso-bidi-font-style: normal;">profound
moment</i>. I wonder if that feeling will stick around. </div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Medical
school continues to be a blast. This week off has been awesome, and I wish that
it didn’t end in a couple of days, but at least the material we are learning
is, I think, really interesting and fairly relevant to our future careers. So,
back to the grind we go. </div>
eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com0tag:blogger.com,1999:blog-2365930991142326796.post-27646465348212832692013-09-15T17:12:00.000-05:002013-09-16T19:11:12.994-05:00Paradigm Shifts, Puppy Therapy, and Pregnancy<!--[if gte mso 9]><xml>
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="35" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="10" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="1" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
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<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
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<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
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<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
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<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
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<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
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<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
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<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
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<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
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<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
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<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
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<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
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<w:LsdException Locked="false" Priority="21" QFormat="true"
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<w:LsdException Locked="false" Priority="31" QFormat="true"
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<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 1"/>
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<![endif]-->Well, I’m
about a month and a half into medical school
<br />
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<br /></div>
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It’s been a hectic
month and a half.</div>
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<br /></div>
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Last Monday,
we had two tests, one of which was a final for the Behavioral Medicine and
Development class (BD). The other was the second of three midterms for
Molecular Cell Biology and Genetics (MCBG) class. It’s nice to have BD over,
and we have one week left of MCGB before anatomy starts. I’m looking forward to
it, actually – MCBG has essentially been an intense undergraduate course with a
clinical application here and there. While interesting, once we start anatomy I’ll
feel like we’re actually getting somewhere. Oh, and after the tests, the school
brought in some dogs for the students to pet – “puppy therapy,” they called it.
As funny as it seemed, it actually was a bit therapeutic to spend some time
with one of the labs!</div>
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<br /></div>
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Before
starting medical school, I heard some medical students comment about the
paradigm shift that often occurs once you start. In undergrad, those of us who
are now in medical school were all neurotic type A folks (<i style="mso-bidi-font-style: normal;">ok, that hasn’t changed</i>) who were generally at the top of our
class. I don’t say that to boast – we had to be. We had something to prove. Now,
though, we’re all together in one room. That means that many of us who used to be
at the top are now… average. That’s not a bad thing. It would be an honor to be
even in the lower echelons of a class full of people as intelligent and
dedicated as my classmates. It’s just different. </div>
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<br /></div>
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I for, one,
am still regularly impressed by the quality of my classmates. These people are
smart. It’s not infrequently that I get the sneaking sensation that I’m not
supposed to be here; that I’m an imposter of sorts. The rate at which these
people can acquire and regurgitate large volumes of information, seemingly
without effort, never ceases to impress. I’ve generally never been one who
could simply hear something once and retain it forever – I need to work at it.
Hard. That translates into hours spent studying just to try and stay caught up
in things like small group sessions. Of course, I’m sure my classmates are
putting in some daunting legwork themselves, but if they are, most of them seem
no worse for the wear. Ah well. </div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
On that note,
<a href="http://www.dysgraphicmusings.com/2013/06/how-to-spend-summer-before-medical.html" target="_blank">Anki </a>has continued to be a great tool for me. I need that regular, daily
repetition to really make things sink in. I wish I would have used it, at least
to some extent, in undergrad. I would have retained a heck of a lot more. Its
efficacy cannot be overstated, at least in my case. </div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<b style="mso-bidi-font-weight: normal;">What to Expect When You’re Expecting</b></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Now for the
more interesting news – we found out during the first week of medical school
that my wife is pregnant! We’re both very excited, and looking forward to next
spring. </div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
When my wife
told me that she was pregnant, my first reaction was one of complete excitement.
That was quickly followed by a reaction similar to Gary Cooper’s in the film <i style="mso-bidi-font-style: normal;">What to Expect When You’re Expecting</i>
(not out loud, though!):</div>
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<br /></div>
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<iframe allowfullscreen="" frameborder="0" height="270" src="//www.youtube.com/embed/dSqkWQ-Fm6E" width="480"></iframe></div>
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<br /></div>
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After that,
though, I felt a very profound sense of… responsibility, I suppose. We are going
to raise a child. That is pretty incredible.<br />
<br />
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<br />
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Of course,
this has been a less-than-optimal time to go through the genetics component of
MCBG, where we are learning about all of the chromosomal bad things that can
happen to a developing child. They are rare events, of course, but still! It was
nice to finish that section of the course.</div>
</div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
We both
continue to eagerly look forward to a healthy pregnancy and, hopefully, a smooth
delivery. My poor wife has had to put up with a busy husband and some pretty
nasty nausea. Hopefully that will get a bit better here in a few weeks as she gets
through her first trimester. In the meantime.Zofran is awesome. <span style="font-family: Wingdings; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-char-type: symbol; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;"></span></span></div>
eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com0tag:blogger.com,1999:blog-2365930991142326796.post-49528660846027451602013-08-10T23:21:00.000-05:002013-09-16T19:09:29.199-05:00The First Week of Medical SchoolWow.
<br />
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<br /></div>
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That was
crazy.</div>
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<br /></div>
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I’ve
officially completed my first week of medical school, which is still a little
bit crazy to think about. It was a lot of fun, but wow – it was also a very
busy week. </div>
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<br /></div>
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Stritch has
the curriculum set up in such a way that, at least in the first year, you are
taking one “major” class at a time. There are also two “minor,” much shorter
classes that occur for a few weeks each during the first year while the “major”
class is going on. Underlying all of these classes is a final “doctoring”
course known as Patient-Centered Medicine that runs through the first three
years. Right now, the “major” class is Molecular Cell Biology and Genetics, affectionately
known as MCGB. There is also a “minor” course – Behavioral Medicine and
Development, aka BD. And then, of course, there’s PCM.</div>
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<br /></div>
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So far, most
days have gone from around 8 am to an average of about 2:30 pm, some days
shorter and some longer. One day a week, PCM keeps us around campus until
anywhere from 3:30 pm to 4:30 pm, but it usually gets out early. Looking ahead,
it seems like the days will be a bit shorter after this first semester ends,
which will be nice.</div>
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<br /></div>
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MCBG, the
bane of my existence right now, is essentially a review of all of the cell
biology, biochemistry, and genetics material we learned (or didn’t learn, as
the case may be…) in undergrad. Though the material itself isn’t necessarily
new or particularly complex, the sheer amount of material covered is just short
of overwhelming. It’s manageable on a day-to-day basis, but is enough to quickly
bury you alive if you fall behind. And we have a test after this next week.
Should be fun. </div>
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<br /></div>
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BD is a more
of a “soft” class – not a ton of effort is needed here, although some studying
is certainly useful. It’s actually been a fairly interesting class, and this
week has covered things like child development, elderly development, death and
dying, and women’s health. For the elderly development lecture, the lecturer
invited three of his patients who were around 70 years old to come speak to the
class. At the start of the lecture, only one gentleman had shown up – one of the
others was ill and couldn’t make it, and another was thought to be wandering
the campus somewhere (it turned out she had been waiting in the wrong place).
After the lecturer gave a brief intro, he brought up the elderly gentlemen and
began to ask a few questions, such as “As you entered into this season of life,
what surprised you the most?” and “What were some significant changes that you
noticed?” Unfortunately, the patient would have none of it and refused to stay
on topic. He was a pleasant enough guy, but apparently preferred to joke about
how the women his age were too old for him or how the only time he would lie
was when he was selling cars. When asked what sage advice he would like to pass
on to the young people in the room, he replied lightly, “Eh…they don’t listen
anyway!” One could tell halfway through the interview that the lecturer seemed
to be regretting inviting this particular guest. </div>
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<br /></div>
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Finally, the
other guest arrived and was brought up to the front of the lecture hall. She
actually had some great things to say about getting older, how that affected
her life, and how she had perceived that her various roles in life had changed.
It was a good interview, but the best part was when the lecturer asked what her
interactions with technology were like, to which she replied, “I am not
internet!" That got a quiet chuckle out of the class. Overall, though, it was
very kind of both of them to come in. It was good, at least with the second
guest, to hear some of the things that we had been discussing in class come straight
from the source, as it were. If nothing else, it made for an entertaining
lecture.</div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
In <a href="http://www.dysgraphicmusings.com/2013/06/how-to-spend-summer-before-medical.html" target="_blank">this post</a>, I mentioned that I was planning on using OneNote to take notes in
class and Anki to help retain information. So far, both systems have been
working very well. OneNote is an awesome way to organize all of the information/handouts/powerpoints/online
readings/etc. for each class in one place that is easily accessible, flexible,
and extremely portable. Anki has been an excellent learning tool. It takes a
little bit of effort to make the cards initially, and one does have to commit
to a daily review of any due flashcards to make it truly effective, but I think
it will be worth it. In undergrad, I feel like I learned the basic concepts of most
things but really tended to cram much of the rest of the information I needed
for exams, and then never really thought about the info again. I really want
things to be different this time around, and I feel like Anki will greatly help
in retaining the information over the long term. </div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
As I
mentioned before, most days end around 2:30 pm or so. I usually go home, spend
a few minutes with my wife (we decided early on that we would spend at least
ten minutes or so together as soon as I walked in the door, just to connect and
hear about each other’s day), and then study for 3-4 hours. This usually
involves reviewing that day’s lectures, making flashcards, reviewing
flashcards, doing any reading, and downloading tomorrow’s lecture materials to
OneNote. I try to stop around 6-7 pm for dinner and spend the rest of the
evening with my long-suffering wife. Ideally, I have all of my studying done at
this point, but there were a couple nights that I had to pick things up again
around 10 pm or so and spend another hour or two tying things up. I’m looking
forward to the days getting a bit shorter so I can, as a rule, be done by 6:30
pm or so. </div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
It’s been a hectic
week, but it’s also been a good week. We are both glad that the weekend is
here, and are thoroughly enjoying relaxing and doing a whole lot of nothing as we
gear up for week two.</div>
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<br /></div>
eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com2tag:blogger.com,1999:blog-2365930991142326796.post-68105140423301630102013-08-04T13:38:00.000-05:002013-08-04T21:09:06.973-05:00And So It Begins...<!--[if gte mso 9]><xml>
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beginning of medical school is quickly approaching, but before Loyola lets us
begin the real fun, we had to sit through a week of orientation material. In
reality, it’s a pretty good idea – it provides a venue to meet your classmates,
get used to the facilities, and generally settle in. It was, however,
agonizingly slow at times.
<br />
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<br /></div>
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Orientation
week kicked off this past Monday with a busy administrative day – getting badges,
filling out paperwork, officially registering, figuring out parking, learning
the computer systems, getting fitted for our white coats, ensuring that we are
not the carriers of any terrible diseases, and so on. The staff at Stritch
essentially set up a bunch of booths in the school, gave us a honey-do list,
and set us free…which generally translated to most of us aimlessly wandering
around hoping that we hit every station that we needed to. The day ended with a
barbeque in Miller Meadows, a large forest preserve across the street from the
school. It consisted of food, games, and fun times as we got to know some of
our fellow classmates a little more.</div>
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<br /></div>
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Tuesday and
Wednesday probably the longest days (at least in terms of perceived time).
These days were filled with lectures (a lot of lectures…) by some of the staff and
faculty at Stritch. On Tuesday morning, many of the professors introduced
themselves and their courses. The school provided breakfast and a catered
lunch, which was actually pretty good.</div>
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<br /></div>
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After lunch,
a physician at Stritch gave a “First Patient Presentation” where a real
volunteer patient came in and sat down in front of a 150+ new medical students,
told his story, and allowed himself to be interviewed by the class as a whole
with the staff physician moderating and guiding the entire conversation. It was
actually pretty cool, and the patient eloquently expressed some kind words of
guidance to us as a class regarding our future as physicians and the importance
of trust and kindness in the physician-patient relationship. <span style="mso-spacerun: yes;"> </span>The day ended with a scavenger hunt put on by
the M2s that took the new students throughout the school of medicine and into
the surrounding villages, eventually ending (three hours later…) at a bar in
Forest Park. </div>
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<br /></div>
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Wednesday
was more lectures. The Dean of Stritch School of Medicine, Dr. Brubaker,
started off with a warm welcome to the students. She was eventually followed by
Dean Jones, the assistant dean of admissions who had welcomed each of us into
his office <a href="http://www.dysgraphicmusings.com/2012/10/interview-experience-loyola-stritch.html" target="_blank">on the interview day</a>. He discussed the composition of the class and some
interesting facts about a lot of the new students, which was entertaining. <span style="mso-spacerun: yes;"> </span>He is the guy in charge of admissions, and
mentioned that he and his staff were now just starting a whole new application season,
which was a bit trippy. The rest of the morning was spent with various people
introducing all of the resources available to Stritch students, like the gym,
student services, and all of the activities we could get involved with at the school,
like the Medical Spanish course offered by Spanish-speaking students. After
lunch, we had a financial aid presentation (particularly bad timing, I thought –
after the long morning and a satisfying lunch, we were all ready for a nap…),
and the day ended with a security presentation (where we watched an “active
shooter education video” – at least it was more interesting than financial aid).
Finally, the University Ministry hosted an Ice Cream Social and held a raffle
for various prizes, ranging from gift cards to hospital cafés to school swag. That
night, the school bused the students who wanted to go to Wrigley Field for a
Cubs vs. Brewers baseball game.</div>
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<br /></div>
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Depending on
which orientation group we had been assigned to, about half the class had
either Thursday or Friday off. I had Thursday off, which was a nice break. On Friday,
we had Basic Life Support training and then some of us had gym orientation. The
BLS training, by the way, consisted of way more actual compressions than any
BLS class I had had before (usually, it seems like the instructor watches you
do CPR on a mannequin for 30 seconds and signs you off. This time….not so
much). To top it off, the day was already pretty warm and humid and the room
was only barely air conditioned, since the class was held in one of the older
buildings on campus. That made for a fun afternoon. That night, though, the
Jesuits had a catered BBQ at their home in Oak Park. That was some darn good
food. </div>
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<br /></div>
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Finally, on
Saturday there was an optional service day. Those who attended met in the
atrium of the school, where we were given a brief introduction to Maywood (the
suburb of Chicago in which Stritch is located) and its history. Then we all dispersed
into various service groups around the village, where we helped hand out food
at homeless shelters, organize food pantries, clean up the community gardens, and
clean up some of the houses around the neighborhood. It was really a lot of fun
and a great way to get to know the area. </div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
But now
orientation week is over, and medical school begins – for real – tomorrow. I’m
actually looking forward to it. It has been nice to have some time off, but it
will also be good to get into somewhat of a routine again. It was great that we
were able to move here a couple of weeks before everything started – having some
time to settle in and get used to the area has been priceless. Some students
just moved in a few days ago – one actually just got married on Friday (that, by
the way, would be crazy!). I don’t envy them. But I’m sure we’ll all have a
blast, and I think everyone is excited for tomorrow. </div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Here goes
nothing!</div>
eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com1tag:blogger.com,1999:blog-2365930991142326796.post-71498194122595905252013-08-01T01:10:00.001-05:002013-08-13T16:23:31.755-05:00Investing Your Money While in Medical School<!--[if gte mso 9]><xml>
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worked hard at your part-time job during undergrad – or maybe you’ve taken some
time off to work at a “real job” – and now you have what seems like more money
than you know what to do with. In reality, perhaps, it’s not much – but you’ve
never had this kind of money before. So what to do with it? Invest it, you say?
That’s an easy way to make a buck, right?
<br />
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
But how the
heck do you do that?</div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Well, for
starters, before you ever come close to purchasing your first mutual fund or
opening up an IRA, stop. Stop and think about the big picture. You have successfully
saved up a few grand. Perhaps you’ve worked really hard and have $15,000 or so
and are feeling quite good about yourself. Or maybe you have even more.<span style="mso-spacerun: yes;"> </span>That’s great. It really is an accomplishment,
but that doesn’t mean it’s time to go find the best and brightest stock picks
and start wheeling and dealing. </div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
First, if
you are about to start the medical school application process, you have a lot
of costs ahead of you. Your AMCAS application, secondaries, a suit, airline
tickets, taxis, food, hotels – all of these things cost money. Quite a chunk of
change, actually. If you’ve made it through the process, awesome – but don’t
forget you probably have to move to medical school. Moving is expensive. You’ll
probably have to buy new furniture, put down a security deposit, and perhaps
even your first month’s rent – all before your loan money arrives in your bank
account. Once all that is taken care of, what if your car breaks down? What if
you trip, fall, break your ankle, have terrible insurance, and get slammed with
a huge medical bill? What if [insert unlikely but costly scenario here]?
Obviously – hopefully – none of those things will happen. But it’s smart to be
prepared. Which leads me to the first step you should take with your grand
riches – allocate some of it to an emergency fund.</div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
An emergency
fund is for…umm…emergencies. You probably guessed that. But not the “Oh darn, I
really need that cool new computer/car/video game/whatever” kind. More like
the, “Oh darn, my car just gave up on life and now I need a new one” or “Oh
darn, something bad happened and now I need to support myself from my savings
for a few months.” It’s generally recommended that you have enough money in
your emergency fund such that, if needed, you could support yourself for about
3-6 months. Once you build it up, you put it in your savings account (or
higher-interest online savings account, such as <a href="https://www.ally.com/" target="_blank">Ally Bank</a>, or perhaps put two-thirds of it in a CD ladder with reasonable
early-withdrawal penalties) and leave it there until it’s needed. If Mr. Murphy
strikes and finds you with your pants down (or at least without an adequate
emergency fund), that could be financially catastrophic for you. </div>
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<br />
In addition to having a solid emergency fund
that you can fall back on to cover unforeseen expenses, you should also have a
handle on your budget. Live below your means. It’s often said that it’s best to
live like a student now so you can live like a doctor later, instead of the
opposite scenario. That doesn’t mean you will be eating Top Ramen for the
majority of the next decade, but it does mean that you should be financially
wise with your resources. Figure out your emergency fund, figure out how much
you can spend each month to stretch your loan money for the year, factor in
rent and utilities, figure out how to cut costs in certain areas if needed, and
don’t spend more than your monthly allowance. It’s really not all that
difficult to figure out. The hard part is sticking to it. </div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Ok, you say.
I’ve done all that. I’ve got a great emergency fund, I’ve developed a picture-perfect
budget spreadsheet in Excel, and I follow it to the letter. I’ve got money left
over, and I still want to invest. Now what?</div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
The first
step is learning about the world of investing. I’ve posted <a href="http://www.dysgraphicmusings.com/2013/06/how-to-spend-summer-before-medical.html" target="_blank">before</a>
about some resources that you could read to learn a bit, but I’ve reposted some
relevant links below for your convenience, and added a few new resources.</div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<a href="http://whitecoatinvestor.com/new-to-the-blog-start-here/" target="_blank">The White Coat Investor</a></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
This is a
great resource for medical students and residents in particular, but also for
anyone interested in investing. It is written by an emergency medicine
physician, and has a lot of great info about all sorts of things. I would highly
recommend reading all of the articles linked in his “First-Timers!” section
from top to bottom. </div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<a href="http://www.fool.com/how-to-invest/index.aspx?source=ifltnvpnv0000001" target="_blank">The Motley Fool</a></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
What is the difference
between a Roth IRA and a traditional IRA? What’s a 529? How do mutual funds
work? The answers to these questions and more can be found here. I recommend
reading at least through all of the articles under the tabs “How to Invest” and
“Retirement” to get a general idea of what’s going on. One word of caution:
This site offers a lot of great free content, but has to make money somehow.
This often comes in the form of “hot stock tips” newsletters and what not.
Ignore these. </div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<a href="http://www.bogleheads.org/wiki/Getting_Started" target="_blank">The Bogleheads' Wiki</a>
and <a href="http://www.bogleheads.org/forum/index.php" target="_blank">The Bogleheads' Forum</a></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
Don’t be
thrown off by the strange-sounding name – this wiki and the associated forum
are one of the one of the best resources online for learning about investing
and finance. Spend some time here – it will serve you well in the future. If
you have any questions, ask away in the “Help with Personal Investments”
subforum – you can get answers within minutes from many wise individuals,
including those who have authored some of the most common-sense investment
books available today. </div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<a href="http://www.morningstar.com/cover/classroom.html" target="_blank">Morningstar.com’s Investing Classroom</a></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
If you
really want to learn the nitty-gritty details about stocks, mutual funds,
bonds, etc., this is the place to go. It takes some time – I’m still not done
yet – but going through their free classes is an excellent way to learn
some of the finer points of investing. </div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
In addition
to the above websites, I recommend getting your hands on some quality books. </div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<a href="http://www.blogger.com/a%20href=%22http:/www.amazon.com/gp/product/0470067365/ref=as_li_tf_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0470067365&linkCode=as2&tag=dysgramusing-20%22%3eThe%20Bogleheads%27%20Guide%20to%20Investing%3c/a%3e%3cimg%20src=%22http://ir-na.amazon-adsystem.com/e/ir?t=dysgramusing-20&l=as2&o=1&a=0470067365%22%20width=%221%22%20height=%221%22%20border=%220%22%20alt=%22%22%20style=%22border:none%20!important;%20margin:0px%20!important;%22%20/">The
Bogleheads’ Guide to Investing</a></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
This is an
excellent starter book that outlines a basic philosophy of investing that I
believe will serve any reader who is in it for the long haul very well. I
highly recommend getting your hands on a copy of this book and reading it. Once
you are done here, you might want to grab a copy of their next book…
</div>
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<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<a href="http://www.blogger.com/a%20href=%22http:/www.amazon.com/gp/product/0470919019/ref=as_li_tf_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0470919019&linkCode=as2&tag=dysgramusing-20%22%3eThe%20Bogleheads%27%20Guide%20to%20Retirement%20Planning%3c/a%3e%3cimg%20src=%22http://ir-na.amazon-adsystem.com/e/ir?t=dysgramusing-20&l=as2&o=1&a=0470919019%22%20width=%221%22%20height=%221%22%20border=%220%22%20alt=%22%22%20style=%22border:none%20!important;%20margin:0px%20!important;%22%20/">The
Bogleheads’ Guide to Retirement Planning</a> </div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">
This
excellent work details the various nuances of planning for retirement,
including the various kinds of vehicles you can use to stock away
tax-advantaged cash. Honestly, if you read the above links you’ll probably get
a pretty good handle on most of the basics, but you might want to consider
adding this one to your collection at some point. That said, I do highly
recommend their <i style="mso-bidi-font-style: normal;">Guide to Investing</i>. </div>
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<iframe frameborder="0" marginheight="0" marginwidth="0" scrolling="no" src="http://rcm-na.amazon-adsystem.com/e/cm?lt1=_blank&bc1=000000&IS2=1&bg1=FFFFFF&fc1=B14008&lc1=FF5400&t=dysgramusing-20&o=1&p=8&l=as1&m=amazon&f=ifr&ref=tf_til&asins=0470067365" style="height: 240px; width: 120px;"> </iframe><iframe frameborder="0" marginheight="0" marginwidth="0" scrolling="no" src="http://rcm-na.amazon-adsystem.com/e/cm?t=dysgramusing-20&o=1&p=8&l=as1&asins=0470919019&ref=tf_til&fc1=B14008&IS2=1&lt1=_blank&m=amazon&lc1=FF5400&bc1=000000&bg1=FFFFFF&f=ifr" style="height: 240px; width: 120px;"></iframe> </div>
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Some general
main points of the sources above are summarized below:</div>
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<b style="mso-bidi-font-weight: normal;">Avoid Individual Stocks</b></div>
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You are not
an expert stock-picker, and the market is smarter than you are. You can’t beat
it consistently. No one does. But if you try to time the market, you will
underperform it. And you will likely do that fairly consistently. </div>
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<b style="mso-bidi-font-weight: normal;">If You Can’t Beat ‘Em, Join ‘Em</b></div>
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Why limit
yourself to a few poorly-chosen stocks? Why not just buy them all? This is
where index funds come in. These are mutual funds that attempt to replicate a
market index, such as the S&P 500 – a fund that is composed of stocks of
many of the larger companies in the U.S. You can take that even further and buy
an index fund such as the <a href="https://personal.vanguard.com/us/funds/snapshot?FundId=0085&FundIntExt=INT" target="_blank">Vanguard Total Stock Market Index Fund</a>, an index fund that essentially covers the
entire spectrum of the domestic market – big companies, small companies, and
everything in between. If you buy this fund, you are essentially buying over
3500 different stocks. Try doing that on your own. Round out your portfolio
with funds like the <a href="https://personal.vanguard.com/us/funds/snapshot?FundId=0113&FundIntExt=INT" target="_blank">Vanguard Total International Stock Index Fund </a>and the <a href="https://personal.vanguard.com/us/funds/snapshot?FundId=0084&FundIntExt=INT" target="_blank">Vanguard Total Bond Market Index Fund</a>. Do that, and you’ll essentially own the
entire market. </div>
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The beauty
of low cost index funds is that, over time, you will get at least market
returns. Actively managed funds (mutual funds that are essentially run by a
single manager or group of managers) try to beat the market by buying and
selling certain funds according to where he/she/they think the market is going.
Which might sound good in theory. But in reality, in any given year, actively
managed funds underperform the market over two-thirds of the time. Of course,
that means that one-third of actively managed funds are beating the market.
That’s great, but those funds are changing every year, and there’s no way to
know who will be the next winners – or losers. Investing is not a game of
winning and losing, though – it’s a game of not losing. By getting at least
market returns, you are guaranteed to not lose. </div>
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<b style="mso-bidi-font-weight: normal;">Determine Your Asset Allocation</b></div>
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Your asset allocation
(AA) is essentially how much of your money you put in different areas of the
market. For example, you will have to decide how much money you will invest in,
say a Total Stock Market index fund versus a Total Bond Market Index Fund. A
good general rule of thumb here is that your 110 minus your age equals your
equity (or stock) allocation. So, a 30 year old investor might invest 80% of
his money set aside for investing into stocks via index funds and the remaining
20% in fixed-income securities, perhaps via a Total Bond Market index fund. It’s
generally recommended to have at least some type of fixed income allocation.
Over time, this acts as a hedge against market downturns and can even increase your
overall returns as stocks might go one direction and bonds in another in
varying market environments. </div>
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An easy way
to choose and maintain your asset allocation while also investing your money
wisely (especially if you could care less and would rather have a hands-off
approach) is to simply buy a Target Retirement fund, such as the ones that
Vanguard offers <a href="https://personal.vanguard.com/us/funds/vanguard/TargetRetirementList" target="_blank">here</a>,
or a LifeStrategy Fund, which can be found<a href="https://personal.vanguard.com/us/funds/vanguard/LifeStrategyList" target="_blank"> here</a>.
These funds invest in all of the funds I mentioned above, thereby allowing to
you cover the entire market in one fell swoop that you never have to think
about again, if you don’t want to.
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<b style="mso-bidi-font-weight: normal;">Invest for the Long Term </b></div>
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Investing
your money in the market comes with a certain degree of risk – namely, at
certain times, you might actually lose money. But the general trend of the
market is up, and if you keep your head on straight and don’t sell your
investments in a panic (thereby locking in your losses), you will, over time,
regain your lost money and then some. All that takes time, though. Don’t invest
any money in the stock market that you will need in the next 7-10 years.
Short-term goals are better suited to CDs and high-interest (relatively
speaking…) savings accounts. </div>
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<b style="mso-bidi-font-weight: normal;">Now what?</b></div>
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So how do
you buy these funds? I won’t go into too much detail here about the different
ways you can invest (e.g. via Roth IRA, Traditional IRA, 401(k), 403(b),
taxable accounts, etc. – that’s what the above resources are for!) except to
say that, for someone just entering medical school, the best investment option
(if indeed it is appropriate to invest in the first place) is probably via a
Roth IRA. Think of a Roth IRA (or any of the vehicles mentioned above) as a bucket
in which you hold various types of investments, such as stocks, bonds, etc. A
Roth IRA is not an investment in of itself. Each different bucket has different
benefits. In this case, you contribute to a Roth IRA with post-tax money, but
all of the money you earn within that “bucket” will be available to you in
retirement tax-free. Additionally, the money that you contributed can be
withdrawn without penalty, which may prove helpful in a time of extreme need. </div>
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The catch,
of course, is that you need earned income to be able to qualify for
contributions to a Roth IRA. That means that if you haven’t earned at least as
much money as you plan you contribute in the past tax year, you are out of
luck. But don’t let that stop you. Spend time now pouring over the resources
above and learning about all of this now. Becoming familiar with sound
investing principles now will pay off in a huge way later. Good luck to you in
your journey, and feel free to post any questions you might have in the
comments section below.</div>
eefenhttp://www.blogger.com/profile/13534007697879981660noreply@blogger.com1